Form Rev-1338a - Liquid Fuels And Fuels Tax Locations Listing
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1REV-1338A MF (2-13)
LIQUID FUELS
AND FUELS TAX
LOCATIONS LISTING
BUREAU OF MOTOR AND
ALTERNATIVE FUEL TAXES
Attach to REV-1338, Application for
PO BOX 280646
Liquid Fuels and Fuels Tax Permit.
HARRISBURG, PA 17128-0646
Please check appropriate box or boxes in each column for each location and indicate tank cap in gallons.
Distributor’s Name
FEIN/SSN
Wholesale
Fuel Type:
Owned
Tank Cap.:
Liq. Fuels
Location Address: (Provide County)
Retail
Fuels
(Gallons)
Leased
Key/Card
Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
£
£
= Wholesale
= Liq. Fuels
£
Owned
£
£
= Retail
= Fuels
£
Leased
£
£
= Key/Card
= Other
Duplicate this form as necessary to complete listing.
In accordance with the federal Privacy Act, the Social Security number/employer identification number herein requested is required
pursuant to 75 Pa.C.S. § 9003(b) and will be used to establish distributor identity and to perform inter-jurisdiction accounting. Such
numbers may only be divulged for official purposes.
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