Form 3712 - Motor Fuel Tax License Application Page 3

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3712, Page 3

PART 4: CARRIER INFORMATION (Pipeline or Marine Vessel moving fuel above the terminal rack.)

27. Will you be a shipper of record on one of the commercial pipelines serving the State of Michigan?

Yes

If yes, name of pipeline

FEIN

28. a. Will you own or operate a commercial pipeline serving Michigan?

Yes

If yes, operating as

b. Will you own or operate a marine vessel serving Michigan?

Yes

If yes, operating as

PART 5: REFINER INFORMATION

Biofuels

29a. Will you produce fuel-grade ethanol or biodiesel? ..........................................................................................................

Yes

29b. Will you disburse fuel-grade ethanol or biodiesel from a rack? ........................................................................................

Yes

30a. Will you produce another type of biofuel capable of powering a motor vehicle? ..............................................................

Yes

30b. Will you disburse that fuel from a rack?............................................................................................................................

Yes

If yes, please attach statement explaining.

31. Provide address of production facility, fuel type and annual capacity.

Address

Fuel Type

Annual Capacity

Petroleum

32. Will you refine any petroleum products?

Yes

If yes, list address for each refinery (Attach additional sheets if necessary).

Street Address

City

State

IRS Terminal Control Number

33. Total gallons of product refined. Attach additional sheets if necessary.

Estimated monthly gallons of

Estimated monthly gallons removed across

petroleum products refined at your

the rack from

Product

Michigan refinery(ies)

refinery(ies) in Michigan

34. Are there terminals within 5 mles of your facility?

Yes

If yes, list each address (Attach additional sheets if necessary).

Street Address

City

State

IRS Terminal Control Number

PART 6: TERMINAL OPERATOR INFORMATION

Attach copies of Terminal Lease Agreements/Throughout Agreements. See instructions for acceptable criteria for agreements.

35. Will you own/operate terminals in the state of Michigan?

Yes

If yes, how many?

36. Will you own/operate a terminal(s) in another state or country from which fuel will be delivered into Michigan?

Yes

37. Will Michigan destined fuel from terminals outside of Michigan be treated the same as fuel withdrawn from Michigan terminals?

Yes

38. Identify all terminals in Michigan, and all terminals in another state or country from which fuel will be delivered into Michigan. (Attach additional

sheets if necessary).

Out of state Terminals Method

Name & Terminal Control Number

Address

Storage Capacity

of delivery into Michigan