Form Tc-107 - Fuel License Application
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Utah State Tax Commission
TC-107
210 N 1950 W, Salt Lake City, UT 84134
Rev. 5/05
Fuel License Application
To Applicant:
READ this page to determine what type of fuel license(s) or account you qualify for.
• If you qualify for any of the fuel licenses, check the appropriate box(es).
• If you qualify for fuel licenses or accounts, complete the information on page 2 and QUESTIONS on page 3.
• Before submitting this application, review the check list for each license or account to make sure you have provided all information and documents
required for processing your application.
Effective date (mm/dd/yy)
Monthly estimated tax
Special Fuel Supplier
(For importers, refiners or blenders of diesel fuel)
QUALIFICATIONS: (Check all boxes that apply to you. If none, you do not qualify)
Imports
Produces, refines, manufactures,
Acquires for distribution or sale in this
NONE. If you check this box, you do not
diesel
or blends diesel fuel
state, diesel fuel not previously taxed
quality for a Special Fuel Supplier License
If you QUALIFY, complete pages 2 and 3.
BOND: A bond is required in compliance with Utah Code §59-13-302, with a minimum amount of $50,000, not to exceed $500,000. Also, the
Tax Commission may periodically review your account and require an adjustment to your bond amount. Attach a completed Surety Bond,
form TC-763.
Effective date (mm/dd/yy)
Monthly estimated tax
Motor Fuel License
(For importers, refiners, manufacturers, or wholesalers of gasoline)
QUALIFICATIONS: (Check all boxes that apply to you. If none, you do not qualify)
Blends
Produces, refines, manufactures or compounds
Imports motor fuel for use, distribution or sale
motor fuel for use, distribution or sale
Purchases motor fuel for resale in wholesale quantities to retail
NONE. If you check this box, you do not
dealers inside or outside of Utah (does not require a license, if all
qualify for a Motor Fuel License
Utah tax is paid to a Utah licensed distributor)
If you QUALIFY, complete pages 2 and 3.
BOND: A bond is required in compliance with Utah Code §59-13-203.1, with a minimum amount of $50,000, not to exceed $500,000. Also,
the Tax Commission may periodically review your account and require an adjustment to your bond amount. Attach a completed Surety
Bond, form TC-763.
Effective date (mm/dd/yy)
Monthly estimated tax
Aviation Fuel License
(For importers, refiners, manufacturers, or wholesalers of aviation or jet fuel)
QUALIFICATIONS: (Check all boxes that apply to you. If none, you do not qualify)
Blends
Produces, refines, manufactures or compounds
Imports aviation fuel for use, distribution or sale
aviation fuel for use, distribution or sale
Purchases aviation fuel for resale in wholesale quantities to
Makes aviation fuel retail sales to both federally certificated air
retail dealers inside or outside of Utah (does not require license,
carriers and other persons
if all Utah tax is paid to a Utah licensed distributor)
NONE. If you checked this box, you do not qualify for an Aviation Fuel License.
If you QUALIFY, complete pages 2 and 3.
BOND: A bond is required in compliance with Utah Code §59-13-203.1 and 59-13-403, with a minimum amount of $50,000, not to exceed
$500,000, UNLESS the monthly average tax liability is $500 or less and retail sales of aviation fuel are made to both federally
certificated air carriers and other persons. Also, the Tax Commission may periodically review your account and require an adjustment to
your bond amount. Attach a completed Surety Bond, form TC-763.
Effective date (mm/dd/yy)
Monthly estimated tax
Environmental Assurance Fee
(For importers, refiners, or manufacturers with the first sale or use in Utah of any petroleum product liquid at 60° Fahrenheit)
Imports petroleum products for
Produces, refines, manufactures or compounds
use, distribution or sale
petroleum products for use, distribution or sale
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