Form 80-001 - Iowa Motor Fuel Tax License Application Page 2
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2Definitions of the Types of Motor Vehicle Fuel Licenses
VII. OWNERS, GENERAL PARTNERS, CORPORATE
00 Liquefied Petroleum Gas Consolidated Location: A consolidated LPG
OFFICERS AND RESPONSIBLE PARTIES
dealer or user return may be filed by any dealer or user with multiple
locations. If you wish to file a consolidated return, an application for each
Print the names and Social Security Numbers of all.
location must be attached to the application for the consolidated location. A
Attach additional sheets of paper if necessary.
separate consolidated location number is necessary for dealer locations and
user locations.
Name: _____________________________________________
01 Liquefied Petroleum Gas Dealer: A person who delivers untaxed LPG
into the supply tank of another person’s motor vehicle for highway or
SSN: ______________________________________________
aircraft use.
Name: _____________________________________________
02 Liquefied Petroleum Gas User: A person who dispenses untaxed LPG
SSN: ______________________________________________
from bulk storage into the fuel supply tank of his or her own motor vehicle
for highway or aircraft use.
Name: _____________________________________________
04 Supplier: A person who (a) acquires motor fuel or special fuel by
SSN: ______________________________________________
pipeline or marine vessel from a state, territory, or possession of the United
Name: _____________________________________________
States or from a foreign country for storage at and distribution from a
terminal and who is registered under 26 U.S.C. 4101 for tax-free transactions
SSN: ______________________________________________
in gasoline or (b) produces in this state or acquires by truck, railcar, or
Name: _____________________________________________
barge for storage at and distribution from a terminal, alcohol or alcohol
derivative substances or (c) produces, manufactures, or refines motor fuel
SSN: ______________________________________________
or special fuel in this state.
Name: _____________________________________________
Supplier also includes a person who does not meet the jurisdictional
SSN: ______________________________________________
connection to this state but voluntarily agrees to act as a supplier for purposes
of collecting and reporting the motor fuel or special fuel tax.
Note: A retail dealer or wholesaler who merely blends alcohol with gasoline
IOWA COUNTIES AND COUNTY NUMBERS
before the sale or distribution of the product or a terminal operator who
01-ADAIR
34-FLOYD
67-MONONA
merely handles, in a terminal, motor fuel or special fuel consigned to the
02-ADAMS
35-FRANKLIN
68-MONROE
terminal operator does not qualify as a supplier.
03-ALLAMAKEE
36-FREMONT
69-MONTGOMERY
04-APPANOOSE
37-GREENE
70-MUSCATINE
05 Restrictive Supplier: A person not licensed as an importer but who
05-AUDUBON
38-GRUNDY
71-O’BRIEN
imports motor fuel or undyed special fuel into this state in amounts of less
06-BENTON
39-GUTHRIE
72-OSCEOLA
than 4,000 gallons in tank wagons or in small tanks.
07-BLACK HAWK
40-HAMILTON
73-PAGE
08-BOONE
41-HANCOCK
74-PALO ALTO
06 Importer: A person who imports motor fuel or undyed special fuel in
09-BREMER
42-HARDIN
75-PLYMOUTH
bulk or transports loads into the state by truck, rail or barge.
10-BUCHANAN
43-HARRISON
76-POCAHONTAS
07 Blender: A person who owns and blends alcohol with gasoline to produce
11-BUENA VISTA
44-HENRY
77-POLK
12-BUTLER
45-HOWARD
78-POTTAWATTAMIE
ethanol blended gasoline at a nonterminal location. A blender is also a
13-CALHOUN
46-HUMBOLDT
79-POWESHIEK
person who blends two or more special fuel products at a nonterminal
14-CARROLL
47-IDA
80-RINGGOLD
location where the tax has not been paid on all of the products blended.
15-CASS
48-IOWA
81-SAC
16-CEDAR
49-JACKSON
82-SCOTT
Blender does not include a biodiesel plant, ethanol plant, or blender pumps.
17-CERRO GORDO
50-JASPER
83-SHELBY
08 Compressed Natural Gas Consolidated Location: A consolidated CNG
18-CHEROKEE
51-JEFFERSON
84-SIOUX
dealer or user return may be filed by any dealer or user with multiple
19-CHICKASAW
52-JOHNSON
85-STORY
20-CLARKE
53-JONES
86-TAMA
locations. If you wish to file a consolidated return, an application for each
21-CLAY
54-KEOKUK
87-TAYLOR
location must be attached to the application for the consolidated location. A
22-CLAYTON
55-KOSSUTH
88-UNION
separate consolidated location number is necessary for dealer locations and
23-CLINTON
56-LEE
89-VAN BUREN
24-CRAWFORD
57-LINN
90-WAPELLO
user locations.
25-DALLAS
58-LOUISA
91-WARREN
09 Compressed Natural Gas Dealer: A person who delivers untaxed CNG
26-DAVIS
59-LUCAS
92-WASHINGTON
into the supply tank of another person’s motor vehicle for highway or
27-DECATUR
60-LYON
93-WAYNE
28-DELAWARE
61-MADISON
94-WEBSTER
aircraft use.
29-DES MOINES
62-MAHASKA
95-WINNEBAGO
10 Compressed Natural Gas User: A person who dispenses untaxed CNG
30-DICKINSON
63-MARION
96-WINNESHIEK
in this state from bulk storage into the fuel supply of his or her own motor
31-DUBUQUE
64-MARSHALL
97-WOODBURY
32-EMMET
65-MILLS
98-WORTH
vehicle for highway or aircraft use.
33-FAYETTE
66-MITCHELL
99-WRIGHT
11 Exporter: A person who acquires fuel in this state for export to another
state. This person must be licensed in another state. No return required.
MAIL COMPLETED
FOR ASSISTANCE, CALL...
12 Eligible Purchaser: A distributor of motor fuel or special fuel. No
APPLICATION TO...
1-800-367-3388
(Iowa,
return required.
Iowa Department of Revenue
13 Eligible Purchaser End User: An end user of special fuel who has
Omaha, Rock Island/Moline)
Compliance: Fuel Tax Unit
purchased a minimum of 240,000 gallons of special fuel in each of the
or
preceding two years. No return required.
PO Box 10456
515-281-3114
14 Storage Facility: A motor fuel, alcohol, or special fuel storage and
Des Moines IA 50306-0456
(local, out of state)
distribution facility (terminal or nonterminal) from which fuel is delivered
into, stored within, withdrawn from, or sold from. This includes ethanol
OR FAX TO 515-281-3756
E-mail: idr@iowa.gov
and biodiesel plants.
15 Transportation: A person involved in the movement of motor fuel or
special fuel imported into the state, who is not the owner of the motor fuel
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or special fuel.
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18 Environmental Protection Charge: A person depositing, or causing to
be deposited, petroleum in a qualifying underground or aboveground storage
tank in Iowa.
80-001 (4/21/09)
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