Form TOB: CTA "Application for a Permit to Deliver Motor Fuels Into a Cargo Tank" - Alabama

What Is Form TOB: CTA?

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 May 1, 2017;
  • 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 TOB: CTA by clicking the link below or browse more documents and templates provided by the Alabama Department of Revenue.

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Download Form TOB: CTA "Application for a Permit to Deliver Motor Fuels Into a Cargo Tank" - Alabama

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A
D
R
LABAMA
EPARTMENT OF
EVENUE
TOB: CTA
B
& L
T
D
5/17
USINESS
ICENSE
AX
IVISION
Reset
P. O. Box 327495 • Montgomery, AL 36132-7495 • (334) 353-7827
www.revenue.alabama.gov
Application For A Permit To Deliver Motor Fuels Into A Cargo Tank
As Provided By Act #93-628, Section 22-35-5, As Amended
(THIS APPLICATION DOES NOT CONSTITUTE A PERMIT)
APPLICANT’S NAME
ADDRESS
CITY
STATE
ZIP
CONTACT PERSON
TITLE
E-MAIL ADDRESS
FEIN
SSN
TELEPHONE NUMBER
OR
(
)
Indicate legal structure:
Individually owned   
Partnership   
Corporation   
Limited Liability Co. (LLC)   
Other ____________________
List below the names, identifying number (social security or FEIN number), and address of all owners, partners, corporate officers, and
LLC members. Attach additional sheets if space is not sufficient.
NAME
SSN/FEIN (Identifying #)
TITLE
HOME ADDRESS
If you are a LLC, are you a
single-member or
multi-member
For Federal income tax purposes, have you filed Internal Revenue Service (IRS) form 8832 electing to be treated as a corporation?
Yes   
No    If yes, please attach a copy to this form.
COMPLETE THE REVERSE SIDE OF THIS APPLICATION
AFFIDAVIT
State _________________________ County ____________________________ I, _________________________________________
(NAME OF PERSON MAKING AFFIDAVIT)
the ___________________________________ of the _______________________________________________________________
(TITLE)
(NAME OF BUSINESS)
whose address is ________________________________________________________________________________ , first being duly
sworn, depose and say upon oath that the statement here submitted is full, true and correct to the best of my knowledge and belief.
Signature of affiant ______________________________________________________
Subscribed and sworn to before me this the __________ day of ____________________________ , ________
Signature of Notary Public ________________________________________________
My commission expires _________________________________________ , ________
Note: If you are a multi-member LLC, a separate affidavit must be completed by each member unless form TOB: LLC-AUTH1 is
completed authorizing a designated member.
OFFICE USE ONLY – APPROVAL FOR PERMIT
____________________________________________ _____________________ ____________________________
SUPERVISOR / MANAGER
EFFECTIVE DATE
PERMIT NUMBER
A
D
R
LABAMA
EPARTMENT OF
EVENUE
TOB: CTA
B
& L
T
D
5/17
USINESS
ICENSE
AX
IVISION
Reset
P. O. Box 327495 • Montgomery, AL 36132-7495 • (334) 353-7827
www.revenue.alabama.gov
Application For A Permit To Deliver Motor Fuels Into A Cargo Tank
As Provided By Act #93-628, Section 22-35-5, As Amended
(THIS APPLICATION DOES NOT CONSTITUTE A PERMIT)
APPLICANT’S NAME
ADDRESS
CITY
STATE
ZIP
CONTACT PERSON
TITLE
E-MAIL ADDRESS
FEIN
SSN
TELEPHONE NUMBER
OR
(
)
Indicate legal structure:
Individually owned   
Partnership   
Corporation   
Limited Liability Co. (LLC)   
Other ____________________
List below the names, identifying number (social security or FEIN number), and address of all owners, partners, corporate officers, and
LLC members. Attach additional sheets if space is not sufficient.
NAME
SSN/FEIN (Identifying #)
TITLE
HOME ADDRESS
If you are a LLC, are you a
single-member or
multi-member
For Federal income tax purposes, have you filed Internal Revenue Service (IRS) form 8832 electing to be treated as a corporation?
Yes   
No    If yes, please attach a copy to this form.
COMPLETE THE REVERSE SIDE OF THIS APPLICATION
AFFIDAVIT
State _________________________ County ____________________________ I, _________________________________________
(NAME OF PERSON MAKING AFFIDAVIT)
the ___________________________________ of the _______________________________________________________________
(TITLE)
(NAME OF BUSINESS)
whose address is ________________________________________________________________________________ , first being duly
sworn, depose and say upon oath that the statement here submitted is full, true and correct to the best of my knowledge and belief.
Signature of affiant ______________________________________________________
Subscribed and sworn to before me this the __________ day of ____________________________ , ________
Signature of Notary Public ________________________________________________
My commission expires _________________________________________ , ________
Note: If you are a multi-member LLC, a separate affidavit must be completed by each member unless form TOB: LLC-AUTH1 is
completed authorizing a designated member.
OFFICE USE ONLY – APPROVAL FOR PERMIT
____________________________________________ _____________________ ____________________________
SUPERVISOR / MANAGER
EFFECTIVE DATE
PERMIT NUMBER
COMPLETE ALL OF THE FOLLOWING QUESTIONS
1.  Are you an operator of a motor fuels bulk facility in the state of Alabama from which a first withdrawal from bulk is
made?
Yes     
No
2.  Do you import motor fuels from another state into the State of Alabama?
Yes     
No
3.  Do you currently have an Alabama motor fuels license?
Yes     
No
If the answer is yes, indicate your motor fuels license number(s).
______________________________________________________________________________________________
______________________________________________________________________________________________
4.  If you are an importer of motor fuels into Alabama, from which state(s) do you export these fuels?
______________________________________________________________________________________________
______________________________________________________________________________________________
5.  Are you currently licensed in states other than Alabama?
Yes     
No
If so, indicate state(s) and license number(s).
______________________________________________________________________________________________
______________________________________________________________________________________________
6.  List the types of motor fuels you handle or distribute. (Motor fuels include all grades of gasoline including gasohol or
any gasoline blend, any components used in any gasoline blend, ethanol, #1 diesel, #2 diesel, or any diesel blend,
biodiesel, kerosene, and all aviation fuels.)
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
7.  Are you registered with the Alabama Secretary of State?
Yes     
No
NOTE: In addition to the charges covered by this application which are levied on operators of bulk facilities and importers
of fuel and collected by the Department of Revenue, there is also a fee levied on the owners of underground and
aboveground storage tanks that is collected by the Alabama Department of Environmental Management. For further
information concerning this fee contact:
Alabama Department of Environmental Management
Ground Water Branch
1400 Coliseum Blvd.
Montgomery, AL 36110
334 / 270-5655
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