Application For A Permit To Deliver Motor Fuels Into A Cargo Tank - Alabama Department Of Revenue Page 2

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COMPLETE ALL OF THE FOLLOWING QUESTIONS
1. Are you an operator of a motor fuels bulk facility in the state of Alabama from which a first withdrawal from bulk is
made?
Yes
No
2. Do you import motor fuels from another state into the State of Alabama?
Yes
No
3. Do you currently have an Alabama motor fuels license?
Yes
No
If the answer is yes, indicate your motor fuels license number(s).
______________________________________________________________________________________________
______________________________________________________________________________________________
4. If you are an importer of motor fuels into Alabama, from which state(s) do you export these fuels?
______________________________________________________________________________________________
______________________________________________________________________________________________
5. Are you currently licensed in states other than Alabama?
Yes
No
If so, indicate state(s) and license number(s).
______________________________________________________________________________________________
______________________________________________________________________________________________
6. List the types of motor fuels you handle or distribute. (Motor fuels include all grades of gasoline including gasohol or
any gasoline blend, any components used in any gasoline blend, ethanol, #1 diesel, #2 diesel, or any diesel blend,
biodiesel, kerosene, and all aviation fuels.)
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
7. Are you registered with the Alabama Secretary of State?
Yes
No
NOTE: In addition to the charges covered by this application which are levied on operators of bulk facilities and importers
of fuel and collected by the Department of Revenue, there is also a fee levied on the owners of underground and
aboveground storage tanks that is collected by the Alabama Department of Environmental Management. For further
information concerning this fee contact:
Alabama Department of Environmental Management
Ground Water Branch
1400 Coliseum Blvd.
Montgomery, AL 36110
334 / 270-5655

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