Form Mft-16b - Exempt Entity Special Fuel Bulk Tank Information Form printable pdf download

Form Mft-16b - Exempt Entity Special Fuel Bulk Tank Information Form

ANY CHANGES TO THE

INFORMATION PROVIDED

BELOW, OR ANY ADDITIONAL

TANKS, MUST BE REPORTED

TO THIS OFFICE. WHEN

CHANGES OCCUR, PLEASE

PROVIDE A LETTER, ON

STATE OF DELAWARE

OFFICIAL LETTERHEAD,

DEPARTMENT OF TRANSPORTATION

INDICATING SUCH, ALONG

MOTOR FUEL TAX ADMINISTRATION

WITH THIS FORM.

OFFICE USE ONLY

P.O. DRAWER E

EXEMPTION NUMBER:

DATE APPROVED:

DOVER, DELAWARE 19903-1565

(302) 744-2715

EXEMPT ENTITY SPECIAL FUEL BULK TANK INFORMATION FORM

Exempt Entity Name:

Please provide all requested information. Failure to do so will cause delays in processing the Exemption Application. Please complete

as many forms as necessary to include all bulk tanks owned/controlled by the above referenced entity.

Physical Address of Bulk Tank:

(Street Address)

(City)

(Zip Code)

Tank Capacity:

gallons

Name of Special Fuel Supplier:

Supplier's Business Address:

(Street Address)

(City)

(Zip Code)

Delaware License Number of Supplier:

Physical Address of Bulk Tank:

(Street Address)

(City)

(Zip Code)

Tank Capacity:

gallons

Name of Special Fuel Supplier:

Supplier's Business Address:

(Street Address)

(City)

(Zip Code)

Delaware License Number of Supplier:

Physical Address of Bulk Tank:

(Street Address)

(City)

(Zip Code)

Tank Capacity:

gallons

Name of Special Fuel Supplier:

Supplier's Business Address:

(Street Address)

(City)

(Zip Code)

Delaware License Number of Supplier:

Physical Address of Bulk Tank:

(Street Address)

(City)

(Zip Code)

Tank Capacity:

gallons

Name of Special Fuel Supplier:

Supplier's Business Address:

(Street Address)

(City)

(Zip Code)

Delaware License Number of Supplier:

MFT-16B Revised 7/1/07

Form Mft-16b - Exempt Entity Special Fuel Bulk Tank Information Form

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