Form B&L:INSF "Application for an Alabama Inspection Fee Permit" - Alabama

What Is Form B&L:INSF?

This is a legal form that was released by the Alabama Department of Revenue - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2015;
  • The latest edition provided by the Alabama Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form B&L:INSF by clicking the link below or browse more documents and templates provided by the Alabama Department of Revenue.

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Download Form B&L:INSF "Application for an Alabama Inspection Fee Permit" - Alabama

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Reset
A
D
r
B&L: INSF
lAbAmA
epArtment of
evenue
7/15
b
& l
t
D
usiness
icense
Ax
ivision
m
f
s
otor
uels
ection
p.o. box 327540 • montgomery, Al 36132-7540 • (334) 242-9608 • fax (334) 242-1199
www.revenue.alabama.gov
Application for An Alabama inspection fee permit
(THIS APPLICATION DOES NOT CONSTITUTE A LICENSE.)
APPLICANT’S NAME (AS WILL APPEAR ON PERMIT)
STREET ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE
ZIP CODE
SOCIAL SECURITY NUMBER (IF INDIVIDUAL)
FEDERAL IDENTIFICATION NUMBER
(        )
TELEPHONE NUMBER
CONTACT PERSON
E-MAIL ADDRESS
Indicate legal structure:
Individually owned
Partnership
Corporation
LLC
Other: ____________________________________________
State of incorporation/organization: ____________________________________
If LLC, have you elected to be taxed as a corporation under federal income tax laws?
Yes
No. If yes, please attach a copy of IRS election form 8832.
List below names, titles, social security numbers and legal addresses of owner, partners or corporate officers, or LLC members. (Attach a listing if necessary.)
NAME
NAME
NAME
TITLE
TITLE
TITLE
SOCIAL SECURITY NO.
SOCIAL SECURITY NO.
SOCIAL SECURITY NO.
ADDRESS
ADDRESS
ADDRESS
*THIS FEE REQUIRES MANDATORY ELECTRONIC FILING OF RETURNS.    Please initial: ______________
COMPLETE THE REVERSE SIDE OF THIS APPLICATION.
Failure to answer all questions or provide the requested documents
will constitute cause for the rejection of your application by the Alabama Department of Revenue.
CERTIFICATION – ALL APPLICANTS MUST COMPLETE THIS SECTION
I certify that I have read this application and know and understand its contents and that all the information herein is true and accurate. I
understand it is unlawful to knowingly make a false statement on the application and that any violation may be prosecuted.
AUTHORIZED REPRESENTATIVE’S NAME (PLEASE PRINT OR TYPE)
TITLE
AUTHORIZED REPRESENTATIVE’S SIGNATURE
DATE
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
(            )
(            )
Permit will be issued upon approval by Manager.
OFFICE USE ONLY – APPROVAL FOR PERMIT
______________________________________    ______________________________
___________________________
APPROVAL
EFFECTIVE DATE
PERMIT NUMBER
Reset
A
D
r
B&L: INSF
lAbAmA
epArtment of
evenue
7/15
b
& l
t
D
usiness
icense
Ax
ivision
m
f
s
otor
uels
ection
p.o. box 327540 • montgomery, Al 36132-7540 • (334) 242-9608 • fax (334) 242-1199
www.revenue.alabama.gov
Application for An Alabama inspection fee permit
(THIS APPLICATION DOES NOT CONSTITUTE A LICENSE.)
APPLICANT’S NAME (AS WILL APPEAR ON PERMIT)
STREET ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE
ZIP CODE
SOCIAL SECURITY NUMBER (IF INDIVIDUAL)
FEDERAL IDENTIFICATION NUMBER
(        )
TELEPHONE NUMBER
CONTACT PERSON
E-MAIL ADDRESS
Indicate legal structure:
Individually owned
Partnership
Corporation
LLC
Other: ____________________________________________
State of incorporation/organization: ____________________________________
If LLC, have you elected to be taxed as a corporation under federal income tax laws?
Yes
No. If yes, please attach a copy of IRS election form 8832.
List below names, titles, social security numbers and legal addresses of owner, partners or corporate officers, or LLC members. (Attach a listing if necessary.)
NAME
NAME
NAME
TITLE
TITLE
TITLE
SOCIAL SECURITY NO.
SOCIAL SECURITY NO.
SOCIAL SECURITY NO.
ADDRESS
ADDRESS
ADDRESS
*THIS FEE REQUIRES MANDATORY ELECTRONIC FILING OF RETURNS.    Please initial: ______________
COMPLETE THE REVERSE SIDE OF THIS APPLICATION.
Failure to answer all questions or provide the requested documents
will constitute cause for the rejection of your application by the Alabama Department of Revenue.
CERTIFICATION – ALL APPLICANTS MUST COMPLETE THIS SECTION
I certify that I have read this application and know and understand its contents and that all the information herein is true and accurate. I
understand it is unlawful to knowingly make a false statement on the application and that any violation may be prosecuted.
AUTHORIZED REPRESENTATIVE’S NAME (PLEASE PRINT OR TYPE)
TITLE
AUTHORIZED REPRESENTATIVE’S SIGNATURE
DATE
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
(            )
(            )
Permit will be issued upon approval by Manager.
OFFICE USE ONLY – APPROVAL FOR PERMIT
______________________________________    ______________________________
___________________________
APPROVAL
EFFECTIVE DATE
PERMIT NUMBER
B&L: INSF
7/15
Page 2
Answer the following questions. If space is insufficient, attach a listing of the information requested.
All attachments are made part of the application.
1.  List locations and capacities of all current storage facilities of dyed diesel fuel, dyed kerosene, and/or lubricating oil in Alabama.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
2.  Will you import products?
Yes     
No
3.  Will you export products?
Yes     
No
4.  Are you registered with the Alabama Secretary of State?
Yes     
No
If yes, please enter number here: ____  ____  ____ – ____  ____  ____.
You must be registered with the Alabama Secretary of State in order to do business in Alabama except for sole proprietorship or
general partnership.
5.  Are you purchasing/merging with any organization(s) or person(s) that is/was permitted with the Alabama Department of
Revenue?
Yes     
No        If yes, indicate the organization(s) or person(s).
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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