Form Mft-1r - Application For Renewal Of Seller - User'S License - 2000
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1
2STATE OF NEW JERSEY
USE FOR
MFT-1 R (02-00, R-4)
Division of Taxation
RENEWAL
MOTOR FUEL TAX
Application Required by
ONLY
PO Box 189
NJ Motor Fuel Tax Law
Trenton, NJ 08695-0189
APPLICATION FOR RENEWAL OF SELLER - USER’S LICENSE
Complete this application to request a renewal of a Seller-User’s License which is needed whenever “special fuels” (#2 fuel oil, diesel, kerosene, LP gas, home
heating oil, etc.) are purchased or sold within the State of New Jersey. This renewal is for a period of three (3) years. A payment of the fee of $150.00 must
accompany this application. There is no fee to holders of valid New Jersey Motor Fuel Retail Dealer, Wholesale Dealer, or Distributor Licenses. In general,
every Seller-User’s license is subject to the filing of a bond in such form and amount as provided by law. Make check or money order payable to: STATE
OF NEW JERSEY-MFT, on or before April 1.
Make any necessary changes below for 1 - 5
1. FID #
OR
-
-
-
Soc. Sec. # of owner
2. Name________________________________________________________________________________________________________________
(If INCORPORATED - give Corp. Name; IF NOT - give Last Name, First Name, MI of owner(s))
3. Trade Name__________________________________________________
5. Mailing Name and Address -
(if different from farm address)
4. Business Location:
Name________________________________________________
Street_______________________________________________________
Street________________________________________________
City__________________________________________ State
City____________________________________ State
-
Zip Code
Zip Code
-
(Give 9-digit Zip)
(Give 9-digit Zip)
Please fill in all information below:
6. Type of ownership (check one):
¨ NJ Corporation
¨ Sole Proprietor
¨ Partnership
¨ Out-of-State Corporation
¨ Limited Partnership
¨ Other - explain___________________________________________________________________________________________________
7. Telephone Numbers: Contact Person ___________________________________________
Title__________________________________
Daytime: (
) _________ - ___________________Ext_________
Evening: (
) _________ - __________________Ext_________
8. Provide the following information for ALL owners, partners or responsible corporate officers. (If more space is needed, attach rider).
%
NAME
SOCIAL SECURITY NUMBER
HOME ADDRESS
(Last Name, First, M.I.)
OWNED
TITLE
(Street, City, Zip)
NOTE: On a separate sheet of paper provide the names of stockholders owning 10% or more of the outstanding shares of stock in the corporation.
9. List parent company, wholly owned subsidiaries, and/or affiliates ___________________________________________________________________
________________________________________________________________________________________________________________________
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Parent category: Financial