Form Mf-180 - Application For Kansas Qualified Biodiesel Fuel Producer Incentive Page 2
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1
2APPLICATION INSTRUCTIONS
FOR KANSAS QUALIFIED BIODIESEL FUEL PRODUCER INCENTIVE MF-180
This application must be completed and approved to be a qualified biodiesel fuel producer and
to be eligible for the incentive.
Indicate name, street address, city, county, state and zip code for the individual partnership or
corporation making application to the Department of Revenue.
1. List the full and correct name, title and address of the applicant. If the applicant is a partnership,
list the names, titles and addresses of each partner. If the applicant is a corporation, list the
names, titles and full addresses of the officers. A copy of the Articles of Incorporation is
required. If the applicant is a limited liability company, list names, titles and full addresses of the
officers. A copy of the Articles of Organization is required. Attach additional pages if needed.
2. List the Federal Employers Identification Number, or the social security number if you are an
individual owner.
3. Indicate the principal mailing address of the applicant.
4. List the Kansas physical location where the applicant produces biodiesel.
5. Indicate if the location is owned or leased.
6. List the production capacity of the biodiesel plant.
7. Check the appropriate boxes indicating the feedstock materials to be used in the production of
biodiesel. Use the ‘other’ line to indicate any feedstock materials not listed.
8. Indicate the biodiesel production start date.
A copy of your Certificate of Analysis verifying the biodiesel produced meets the American Society
for Testing Materials (ASTM) standards must be attached.
Complete the ‘conditions’ section of the application. The application must be signed by an owner or
officer and must be properly notarized.
Mail the completed application to:
Kansas Department of Revenue
Motor Fuel Tax
915 S.W. Harrison Street
Topeka, Kansas 66625-8000
(785) 368-8222
If you have questions, please contact the Motor Fuel Tax segment at the phone number or address listed.
You will be notified when the application is approved.
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