Form 198-Lgd - Application For Flat Fee Decal(S) Page 2

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Form 198-LGD

Revised 9-2013

State of Oklahoma

Oklahoma Tax Commission

MFF

Application for Flat Fee Decal(s)

(405) 522-4811

Mail to: Oklahoma Tax Commission, Management Services Division, Post Office Box 26920, Oklahoma City, OK 73126-0920

Mailing Address (For All Correspondence)

FEI/SSN Number

Owner, Partnership, or Corporate Charter Name

Street Address

City, State and Zip

Trade Name (Doing Business As)

Business Phone Number

Fax Number

County

I Hereby Make Application for the Following Decal(s):

LPG or Natural Gas Vehicle not Exceeding 1 Ton Capacity, Equipped ............................ $ 50.00

Methanol or “M-85” Vehicle not Exceeding 1 Ton Capacity, Equipped ............................ $100.00

LPG, Methanol or “M-85” Vehicle Over 1 Ton, Equipped ................................................. $150.00

1. The fee is per vehicle per year – January 1 through December 31.

2. If the vehicle is purchased with equipment or equipment is installed on or after July 1 of the current year, the fee is 1/2 for

the remainder of the year (this does not apply to renewals).

3. When any person fails to obtain a current decal within thirty (30) days of the date said decal is required, there shall

become due and payable a penalty of 20%.

Fuel

Enter Complete Motor Vehicle

Vehicle Type

Current

Decal

Identification Number

Auto-Pickup-Van

Type

Make

Year

State

License

Fee

(VIN on Oklahoma Title)

Tag Number

LPG

NG M85

(If more space is needed attach list.)

Total Fee(s)

Decal Number

Year

Date Issued

Total Penalty

Total Amount Enclosed

I declare under the penalties of perjury that this application has been examined by me/us and to the best of my/our knowledge and belief the

facts set forth are true, correct and complete and is made in good faith pursuant to existing law requiring this application.

Signature

Date

Mandatory inclusion of Social Security and/or Federal Identification numbers is required on forms filed with the Oklahoma Tax Commission pursuant to Title

68 of the Oklahoma Statutes and regulations thereunder, for identification purposes, and are deemed part of the confidential files and records of the

Oklahoma Tax Commission.