Form Ap-151-2 - Texas Supplement To Application For Fuels Tax Permit Form - 1998 Page 2
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1
2AP-151-3
(Rev.12-98/4)
Page 2.
TEXAS SUPPLEMENT TO APPLICATION FOR FUELS TAX PERMIT
11. Legal name of owner (Same as Item 1)
12. Taxpayer number
3. Name (Last, first, middle initial)
4. Social Security Number
5. Driver's license no.
State
–
–
6. Home address
City
State
ZIP Code
7. Phone (Area code & number)
/
8. Date of birth
9. Position
02 - Partner
03 - Director
06 - Record keeper
(Check all applicable boxes)
05 - Corporate
04 - Officer
Stockholder
10. Percentage of ownership or corporate stock held
%
c/c
3. Name (Last, first, middle initial)
4. Social Security Number
5. Driver's license no.
State
–
–
6. Home address
City
State
ZIP Code
7. Phone (Area code & number)
/
8. Date of birth
9. Position
02 - Partner
03 - Director
06 - Record keeper
(Check all applicable boxes)
05 - Corporate
04 - Officer
Stockholder
10. Percentage of ownership or corporate stock held
%
c/c
3. Name (Last, first, middle initial)
4. Social Security Number
5. Driver's license no.
State
–
–
6. Home address
City
State
ZIP Code
7. Phone (Area code & number)
/
8. Date of birth
9. Position
02 - Partner
03 - Director
06 - Record keeper
(Check all applicable boxes)
05 - Corporate
04 - Officer
Stockholder
10. Percentage of ownership or corporate stock held
%
c/c
3. Name (Last, first, middle initial)
4. Social Security Number
5. Driver's license no.
State
–
–
6. Home address
City
State
ZIP Code
7. Phone (Area code & number)
/
8. Date of birth
9. Position
02 - Partner
03 - Director
06 - Record keeper
(Check all applicable boxes)
04 - Officer
05 - Corporate
Stockholder
10. Percentage of ownership or corporate stock held
%
c/c
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