Form Tmt-1 - Application For Highway Use Tax (Hut) And Automotive Fuel Carrier (Afc) Certificates Of Registration (C Of R) And Decals

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TMT-1

Department of Taxation and Finance

Application for Highway Use Tax (HUT) and Automotive Fuel

Carrier (AFC) Certificates of Registration (C of R) and Decals

(8/15)

Order your credentials online in minutes at

To use OSCAR all you need is an active USDOT number and a Highway Use Tax ( HUT ) account

— Read the instructions, Form TMT-1-I, before completing this form.

For office use only

— You must complete all lines of this form, except as noted in the instructions. We will return an incomplete application to you.

Number of

Total amount

credentials

— All vehicles with HUT or AFC credentials must display decals.

— This form is available as a fill-in form on our Web site (see Need help? in Form TMT-1-I). Type your information, then print,

sign, and mail it.

Deposit number

1 Identification

Employer identification number

Suffix, if any

Social security number (SSN)

number

2 USDOT number

3 Telephone number

4 E-mail address

5 Fax number

6 Legal name

7 Doing business as (DBA) name, if different from legal name

( number and street )

( if different than physical address; number and street or PO box )

8 Physical address

9 Mailing address

City

State

ZIP code

City

State

ZIP code

( enter if other than United States; do not abbreviate )

Country

Mark an X in the box if your physical or mailing address has changed and has not been reported to us. Enter new address on line 8 and/or line 9, above. If your business

name or tax identification number has changed and has not yet been reported to us, call us before mailing this application (see Need help? in Form TMT-1-I).

Type of business ( mark an X in one box and specify if Other )

Sole proprietor

Corporation

Partnership

LLC

LLP

Other:

12 For new accounts, list the name, title, social security number, and address of each principal officer of a corporation, or of each partner, or member of an LLC/LLP, or

owner if sole proprietorship.

Name

Title

SSN

Number and street

City

State

ZIP code

13 For new accounts, enter the location where tax and mileage records will be available for audit.

Name of custodian of records

Number and street

City

State

ZIP code

Telephone number

14 If this form is prepared by a company employee who is not an officer, partner, member, or owner, or by an agent, service, accountant or other

representative, you must provide the information below. Additionally, if you expect to contact the Tax Department about this application or any other tax

matters, you must attach a Power of Attorney (usually Form POA-1) authorizing you to have access to this business’s New York State tax records.

Name of person preparing form

Number and street

City

State

ZIP code

Telephone number

15 Signature of owner, partner, officer, member or individual with a Power of Attorney on file with the New York State Tax Department

Certification: I certify that the above statements are true, complete and correct and that no material information has been omitted. I make these statements with

the knowledge that willfully providing false or fraudulent information with the intent to evade tax may constitute a felony or other crime under New York State Law,

punishable by a substantial fine and possible jail sentence. I also understand that the Tax Department is authorized to investigate the validity of any information

entered on this document.

Signature

Printed name of person signing

Title

Date signed

Amount due with application. The C of R and decal (credentials) cost $19 per vehicle.

Mail application and payment to:

× $19 = $

Number of HUT/AFC credentials ordered

NYS TAX DEPARTMENT

HUT/IFTA APPLICATION DEPOSIT UNIT

Make check or money order payable in U.S. funds to Commissioner of Taxation and Finance.