Form 3712 - Motor Fuel Tax License Application Page 6
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83712, Page 6
PART 14: LICENSE FEES
Carrier License (Pipeline, Barge, and Marine Vessel)
61. If you answered yes to item 28a or 28b, enter 0 here. There is no fee required for a carrier license .........................
Terminal Operator License (including Refiners)
62. If you answered yes to item(s) 29a, 29b, 30a, 30b, 32, or 35, enter $2000 here ........................................................
63. If you answered yes to item 36 or 37, enter $0 here ...................................................................................................
Supplier
64. If you answered yes to item(s) 41, 42, 43, or 44a, enter $2000 here ..........................................................................
Permissive Supplier
65. If you answered yes to item 44b, enter $50 here ........................................................................................................
Importer
66. Tankwagon Operator Importer: If you answered yes to item 48, enter $50 here .........................................................
67. Bonded Importer: If you answered yes to item 49 and selected 49a, enter $1000 here .............................................
68. Occasional Importer: If you answered yes to item 49 and selected 49b, enter $1000 here ........................................
Exporter
69. If you answered yes to item 50, enter $1000 here ......................................................................................................
Blender
70. If you answered yes to item(s) 51, 52, or 53, enter $100 here ....................................................................................
Transporter
71. If you answered yes to item 55, enter $50 here ...........................................................................................................
Retail Diesel Waterways
72. If you answered yes to item 57, enter $50 here ..........................................................................................................
Liquefied Petroleum Gas
73. If you answered yes to item(s) 58, 59, or 60, enter $50 here ......................................................................................
Documents to be submitted with Motor Fuel License Application
Form 3712, Motor Fuel Tax License Application ..........................................................
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Form 3999, Trading Partner Agreement ......................................................................
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Form 4099, Motor Fuel Electronic Filing Application ...................................................
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Form 4040, Motor Fuel EFT (EFT) Credit Application .................................................
Or Form 4041
Or Form 4041
Form 4041, Motor Fuel EFT Debit Application ............................................................
Or Form 4040
Or Form 4040
If
applicable
Federal 637 Registration .............................................................................................
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Most Current Financial Statements ............................................................................
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X
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Lease Agreements/Through-Put Agreements ............................................................
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X
X
Copies of Licenses from other states or provinces.....................................................
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X
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Parent category: Financial