Aviation Fuel Excise Tax Application

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Indiana Department of Revenue
AVF-1
Departmental Use Only
Aviation Fuel Excise
State Form 55312
Tax Application
(R / 7-13)
License Number: _________________
Effective Date: ___________________
Section A: Taxpayer Information
Contact the department at (317) 615-2625 for more information regarding this application.
Please print legibly or type the information on this application.
1. Owner name, legal name, partnership name, corporate name, or other entity name
2. Federal identification number (FEIN)
3. Business trade name or DBA
4. Name of contact person (owner, partner, or corporate officer)
5. Business location (P.O. box numbers cannot
City
State
Zip Code
County
be used as business location addresses)
6. Mailing address
City
State
Zip Code
County
7. Business location telephone number
8. Fax number
9. Email address
10. If your business is currently registered for any Indiana tax under this ownership, enter your taxpayer identification number (TID)
11. Check the type of organization of this business:
□
□
□
□
□
□
□
□
Sole proprietor
Partnership
Corporation
LLC
LLP
Fed. gov.
Other gov.
Other _____________
12. All corporations answer the following questions
A. State of incorporation
B. Date of incorporation
C. State of commercial domicile
D. If not incorporated in Indiana, enter the date authorized to do business in Indiana
E. Accounting period year ending date
13. Owner, Partners, or Officers (attach separate sheet if necessary.) Social Security numbers are required in accordance with
IC 4-1-8-1.
Social Security
Last Name, First Name,
Number
Middle Initial
Title
Street Address, City, State, Zip Code

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