Form 3712 - Motor Fuel Tax License Application Page 4

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3712, Page 4

39. Identify position holders, by terminal, who own product in the terminals listed above. Terminal outside of Michigan need only identify position holders

that disburse with a Michigan destination (Attach additional sheets if necessary).

Terminal Control Number or Terminal

Position Holder Name

FEIN

Name and Address

40. Will you own/operate a refinery that distributes fuel from a rack?

Yes

IRS Terminal/Refinery Control Number(s) or Address

Name

FEIN

PART 7: SUPPLIER/PERMISSIVE SUPPLIER INFORMATION

Attach copies of Terminal Lease Agreements/Throughput Agreements. Please see instructions for acceptable criteria for agreements.

41. Will you own fuel products stored in terminals in Michigan? ..................................................................................................

Yes

42. Will you own fuel stored in production facilities in Michigan? .................................................................................................

Yes

43. Will you import fuel grade ethanol into Michigan from another state or country? ...................................................................

Yes

44. Will you own fuel products stored in terminals in another state or country?...........................................................................

Yes

If yes:

a. Will you remove fuel products for your own delivery into Michigan? .........................................................................

Yes

b. Will you sell fuel products to customers who will deliver the fuel to Michigan? ........................................................

Yes

45. Identify all owned or leased terminal storage in Michigan, and storage at out-of-state terminals from which fuel destined for Michigan will be with-

drawn (including storage at a biofuel processing plant):

Address of IRS Terminal Control

Method of delivery into storage (Pipeline, Marine

Owner or Terminal Operator

Vessel, Truck, Rail, Production)

Number

PART 8: IMPORTER INFORMATION

46. If you import fuel grade ethanol into Michigan from another state or country, complete Part 7, line 43.

47. If you import fuel products, excluding ethanol, into Michigan from a Michigan licensed supplier at a terminal in another state, you must pay the

Michigan excise tax to the supplier. A license is not required for this activity.

48. Will you import fuel products by tank wagon or railcar from a bulk storage in another state?

Yes

If yes, indicate the state from which you will import, the type of license for that state, and the fuel products. You must also attach a copy of your license

for each state.

Products to be imported (see Form 4667 for a list

State

License Type

of product codes

49. Will you import fuel products from outside the United States?

Yes

Bonded Importer – Required to submit a surety bond in an amount determined by the department, but not less than $2,000,000 unless

you are registered under IRS sec. 4101, in which case the bond may be reduced to no less than $1,000,000.

Occasional Importer – May be required to submit a surety bond in an amount determined by the department, but not to exceed

$2,000,000. Required to pay tax on imported products within 3 days of the earliest of entry into the country or receipt of the import

verification number.