Form R-9008 - Certification Of Payment Of Oil Spill Contingency Fee

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R-9008 (7/10)
Certification of Payment of Oil Spill
Contingency Fee
(R.S. 30:2451-2496)
Special Program Division
P.O. Box 4998
Baton Rouge, LA 70821-4998
(225) 219-7656
(225) 219-2114 (TDD)
______________________________________________________________________
Revenue Account Number
____________________________________________________________________________
This certifies that
Name
_______________________________________ _______________________ _______ __________
Address
Street
City
State
ZIP
is registered with the Louisiana Department of Revenue as a marine terminal operator and is assuming responsibility for remitting the
oil spill contingency fee to the Louisiana Department of Revenue on the following transaction(s):
Date
Owner
Transporter
Number of barrels
By signing this certification, the terminal operator assumes responsibility for payment of the fee and becomes the party whom the
Louisiana Department of Revenue will look for payment. The terminal operator accepting this certification should retain it in his records
for four years.
In lieu of this certification, Form R-9010 (Certification of Continued Responsibility for Payment of Oil Spill Contingency Fee) may be used
when there will be ongoing transactions between two companies that have mutually decided which one will pay the fee to the Louisiana
Department of Revenue.
Area code and telephone number
Signature
Date
(mm/dd/yyyy)

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