Form Tp-650 - Application For Registration Under Articles 12-A And 13-A (Page 3 of 4) in pdf

TP-650 (12/13) Page 3 of 4

16 Capacity of bulk storage tanks you own

.............................................................................................................

gal.

(see instructions)

Capacity of bulk storage tanks you lease or rent from another ...................................................................................................

gal.

Is any motor fuel or diesel motor fuel stored on the site of these bulk storage tanks?

Yes

17 Only distributors of diesel motor fuel should complete line 17

(see instructions)

a. Gallons of diesel motor fuel you expect to sell or use each month in NYS ...........................................................................

gal.

b. Gallons included in 17a that you expect to sell for specific exempt purposes

gal.

..................................................................................

c. Gallons of non-highway diesel motor fuel included in 17a that you expect to sell to other registered distributors ................

gal.

d. Gallons of highway diesel motor fuel included on line 17a sold to a registered distributor within a terminal .........................

gal.

e. Gallons of highway diesel motor fuel included in 17a and purchased tax paid in NYS .........................................................

gal.

18 Only distributors of motor fuel should complete line 18.

Gallons of motor fuel you expect to import, manufacture, refine, produce, or compound each month in NYS .........................

gal.

19 Only importing/exporting transporters should complete line 19.

a. Identify your method(s) of transporting motor fuel (truck, tractor‑trailer, barge, tanker, pipeline, railroad, etc.)

b. Gallons of motor fuel you expect to import into NYS during the next 12 months .................................................................

gal.

c. Gallons of motor fuel you expect to export out of NYS during the next 12 months ..............................................................

gal.

d. List all terminals/storage facilities located in NYS where you load/unload motor fuel:

Location of terminal/facility

20 Only terminal operators should complete line 20

(attach additional sheets if necessary)

a. List all terminals/storage facilities located in NYS where you will store motor fuel or diesel motor fuel.

Location

Owned (O) or

Capacity

Method of

Blending

Type of fuel

Gallons of motor fuel

Leased (L)

supply

distribution

capability

stored

or diesel motor fuel

(Yes or No)

(premium or

handled during the

regular)

last 12 months

b. For all leased terminals/storage facilities listed in line 20a, complete the following:

Lessor’s EIN

Capacity leased

Lease expiration

Location

Lessor’s name and address

or SSN

date

(mm/dd/yy)

c. Do you lease or sublease any terminals listed in line 20a to other persons?

Yes

If Yes, complete the following:

Location

Lessee’s/sublessee’s name and address

Lessee’s/sublessee’s

Capacity leased

Lease expiration

EIN or SSN

date

(mm/dd/yy)

d. List principal suppliers of each terminal/storage facility:

Location of

Supplier’s name and address

Method of

Supplier’s EIN

Gallons supplied

terminal/facility

transportation

or SSN

for last 12 months

e. List principal transporters from each terminal:

Location of

Transporter’s name and address

Method of

Transporter’s EIN

Gallons transported

terminal/facility

transportation

or SSN

during last 12 months

Form Tp-650 - Application For Registration Under Articles 12-A And 13-A Page 3

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