Form B&L: MFT-APP "Alabama Motor Fuel Excise Tax License Application" - Alabama

What Is Form B&L: MFT-APP?

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 August 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 printable version of Form B&L: MFT-APP 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: MFT-APP "Alabama Motor Fuel Excise Tax License Application" - Alabama

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A
D
R
LABAMA
EPARTMENT OF
EVENUE
B&L: MFT-APP
B
& L
T
D
USINESS
ICENSE
AX
IVISION
8/17
M
F
S
OTOR
UELS
ECTION
P. O. Box 327540 • Montgomery, AL 36132-7540 • (334) 242-9608 • Fax (334) 242-1199
Alabama Motor Fuel Excise Tax License Application
https://revenue.alabama.gov
PLEASE READ INSTRUCTIONS PRIOR TO COMPLETING APPLICATION
PLEASE PRINT IN INK OR TYPE
A. APPLICANT INFORMATION
LEGAL BUSINESS OR CORPORATION NAME
FEIN / SSN
TRADE NAME OR DBA (IF DIFFERENT FROM BUSINESS NAME)
FEDERAL CERTIFICATE OF REGISTRY NUMBER
(IRS 637 REGISTRATION NUMBER)
CONTACT PERSON
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
(            )
(            )
B. ADDRESS INFORMATION
PHYSICAL LOCATION (DO NOT USE P.O. BOX)
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
STATE
ZIP CODE
ADDRESS FOR BUSINESS RECORDS
CITY
STATE
ZIP CODE
C. LICENSE INFORMATION (Attach additional pages if necessary.)
Check each license for which you are applying:
Supplier
Importer
Terminal Operator
Motor Fuel Transporter
Aviation Fuel Purchaser
Permissive Supplier
Exporter
Blender
Distributor
Enter 6 digit Entity Number assigned by the
Secretary of State’s Office, if applicable. . . . . . . . . . . . .
You must have an entity number to submit this application, except for sole proprietorship or general partnership.
D. TYPE OF BUSINESS OWNERSHIP
Sole-Owner
Domestic Corporation
Foreign Corporation
General Partnership
Limited Partnership
Limited Liability Partnership
Limited Liability Company
Other (Specify) ____________________________________________________________________________________________________________
State of Incorporation: ________________________________    Date of Incorporation: ___________________________________
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.
Corporation: provide all corporate officers. Partnership: provide all partners. Sole Proprietorship: provide owner.
All Others: provide all general partners, members, or managers. (Attach additional pages if necessary.)
1.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
2.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
3.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
4.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
5.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
A
D
R
LABAMA
EPARTMENT OF
EVENUE
B&L: MFT-APP
B
& L
T
D
USINESS
ICENSE
AX
IVISION
8/17
M
F
S
OTOR
UELS
ECTION
P. O. Box 327540 • Montgomery, AL 36132-7540 • (334) 242-9608 • Fax (334) 242-1199
Alabama Motor Fuel Excise Tax License Application
https://revenue.alabama.gov
PLEASE READ INSTRUCTIONS PRIOR TO COMPLETING APPLICATION
PLEASE PRINT IN INK OR TYPE
A. APPLICANT INFORMATION
LEGAL BUSINESS OR CORPORATION NAME
FEIN / SSN
TRADE NAME OR DBA (IF DIFFERENT FROM BUSINESS NAME)
FEDERAL CERTIFICATE OF REGISTRY NUMBER
(IRS 637 REGISTRATION NUMBER)
CONTACT PERSON
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
(            )
(            )
B. ADDRESS INFORMATION
PHYSICAL LOCATION (DO NOT USE P.O. BOX)
CITY
STATE
ZIP CODE
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
STATE
ZIP CODE
ADDRESS FOR BUSINESS RECORDS
CITY
STATE
ZIP CODE
C. LICENSE INFORMATION (Attach additional pages if necessary.)
Check each license for which you are applying:
Supplier
Importer
Terminal Operator
Motor Fuel Transporter
Aviation Fuel Purchaser
Permissive Supplier
Exporter
Blender
Distributor
Enter 6 digit Entity Number assigned by the
Secretary of State’s Office, if applicable. . . . . . . . . . . . .
You must have an entity number to submit this application, except for sole proprietorship or general partnership.
D. TYPE OF BUSINESS OWNERSHIP
Sole-Owner
Domestic Corporation
Foreign Corporation
General Partnership
Limited Partnership
Limited Liability Partnership
Limited Liability Company
Other (Specify) ____________________________________________________________________________________________________________
State of Incorporation: ________________________________    Date of Incorporation: ___________________________________
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.
Corporation: provide all corporate officers. Partnership: provide all partners. Sole Proprietorship: provide owner.
All Others: provide all general partners, members, or managers. (Attach additional pages if necessary.)
1.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
2.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
3.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
4.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
5.  FULL LEGAL NAME
TITLE
FEIN / SSN
HOME ADDRESS
CITY
STATE
ZIP CODE
E. PRODUCT INFORMATION
Check the type(s) of product you will be handling:
150 – #1 Fuel Oil
125 – Aviation Gasoline
130 Aviation Jet Fuel
122 – Blending Components
124 – Gasohol
065 – Gasoline
228 – Diesel - Dyed
160 – Diesel - Undyed
170 – Biodiesel - Undyed
072 – Kerosene - Dyed
142 – Kerosene - Undyed
100 – Transmix
Other – Product Code: ________ Product Type: _____________________________________
F. MOTOR FUEL PURCHASE/RECEIPT INFORMATION (Attach additional pages if necessary.)
Provide the following information on all suppliers and distributors from whom you will purchase motor fuel. Suppliers must list all exchange partners from
whom you will receive motor fuel from inside the terminal transfer system.
SUPPLIER/DISTRIBUTOR:
POINT OF ORIGIN
POINT OF DESTINATION
NAME
CITY
STATE
CITY
STATE
PRODUCT CODE
EXCHANGE PARTNER:
POINT OF ORIGIN
POINT OF DESTINATION
NAME
CITY
STATE
CITY
STATE
PRODUCT CODE
G. TERMINAL OPERATOR INFORMATION (If you own, operate, or otherwise control a terminal, you must complete this section.)
Will you maintain motor fuel storage and distribution facilities to which a terminal control number has been assigned by the IRS?
No      If yes, you must complete Section P – Storage Facility Information.
Yes     
H. REFINERY INFORMATION (Attach additional pages if necessary.)
If you own, operate, or otherwise control facilities with petroleum-refining capabilities in Alabama you must complete this section.
1. REFINERY STREET ADDRESS
CITY
STATE
ZIP CODE
2. Provide the product code and estimated number of gallons for each product you plan to refine monthly:
PRODUCT CODE
GALLONS
PRODUCT CODE
GALLONS
PRODUCT CODE
GALLONS
I. SUPPLIER INFORMATION (Important: all suppliers must complete Section P – Storage Facility Information.)
As a supplier or permissive supplier you will be set up to file the annual Wholesale Oil License/Import License Fee.
If you are applying for a supplier’s license or permissive supplier’s license, you must complete this section.
1. Are you a position holder at a terminal in Alabama?
Yes     
No      If no, how do you qualify as a supplier? _________________________________________________________________________
2. Will you receive motor fuel through a two-party exchange agreement?
No      If yes, you must complete Section F – Motor Fuel Purchase/Receipt Information.
Yes     
3. Will you only have transactions within the bulk transfer terminal system such as a pipeline?
Yes     
No
4. Estimated quantity of fuel sold each month at the terminal rack:
Gasoline:______________________________________
Diesel Fuel: ___________________________________
Aviation Gas:___________________________________
Jet Fuel: ______________________________________
J. BLENDER INFORMATION (Attach additional pages if necessary.)
If you will blend petroleum products in Alabama, you must complete this section.
What is the estimated number of gallons of product you will blend each month?
Gasoline: _____________________ Diesel Fuel: ____________________
BLENDING SITE PHYSICAL ADDRESS
CITY
STATE
ZIP CODE
TANK CAPACITY (GALLONS)
AL
Provide a complete description of your blending operation:
K. DISTRIBUTOR INFORMATION (If you are applying for a distributor’s license, you must complete this section and Section F.)
1. Will you import motor fuel into Alabama from a permissive supplier?
No      If yes, you must complete Section M – Importer Information.
Yes     
2. Will you export motor fuel from Alabama?
No      If yes, you must complete Section L – Exporter Information.
Yes     
3. Will you purchase motor fuel for resell from a supplier at a terminal in Alabama?
Yes     
No     
4. Will you purchase motor fuel for resell from a licensed distributor in Alabama?
Yes     
No     
5. Estimated quantity of fuel purchased in Alabama each month.
Gasoline: ______________________________________
Diesel Fuel: ___________________________________
Aviation Gas: ___________________________________
Jet Fuel: ______________________________________
L. EXPORTER INFORMATION (Attach additional pages if necessary)
1. Which mode of transportation will you use to export from Alabama? (Check all that apply.)
(If you plan to export motor fuel from Alabama, you must complete this section.)
Transport Vehicle
Railroad Tank Car
Other _____________________________________________________________
2. Will you purchase motor fuel from a licensed supplier and/or distributor?
Yes     
No     
3. Will you export motor fuel from a bulk plant?
Yes     
No     
4. List the state(s) to which you plan to export motor fuel and the License or Registration Number for each of those state(s):
STATE
LICENSE/REGISTRATION NUMBER
STATE
LICENSE/REGISTRATION NUMBER
STATE
LICENSE/REGISTRATION NUMBER
1.
3.
5.
2.
4.
6.
5. Estimated quantity of fuel exported out of Alabama each month.
Gasoline: ______________________________________
Diesel Fuel: ___________________________________
Aviation Gas: ___________________________________
Jet Fuel: ______________________________________
M. IMPORTER INFORMATION (Attach additional pages if necessary)
As an importer you will be set up to file the annual Import License Fee.
(If you plan to import motor fuel into Alabama, you must complete this section.)
1. Will you import motor fuel that you receive from a permissive supplier?
Yes     
No    If yes, you will be required to be licensed as an importer and report monthly.
2. Do you plan to import motor fuel from a bulk plant or some other non-terminal storage located in another state?
Yes     
No    If yes, you will be required to be licensed as an importer and report monthly.
3. Do you plan to import motor fuel acquired at an out-of-state terminal from a supplier who will not precollect the Alabama tax?
Yes     
No    If yes, you will be required to be licensed as an importer and pay the Alabama tax on or before the third day after the fuel is imported.
4. What mode of transportation will you use to import into Alabama? (Check all that apply.)
Transport Vehicle
Railroad Tank Car
Other _____________________________________________________________
5. List the state(s) from which you plan to import motor fuel and the License or Registration Number for each of those state(s):
STATE
LICENSE/REGISTRATION NUMBER
STATE
LICENSE/REGISTRATION NUMBER
STATE
LICENSE/REGISTRATION
1.
3.
5.
2.
4.
6.
6. Estimated quantity of fuel imported into Alabama each month.
Gasoline: ______________________________________
Diesel Fuel: ___________________________________
Aviation Gas: ___________________________________
Jet Fuel: ______________________________________
N. MOTOR FUEL TRANSPORTER INFORMATION (If you plan to transport motor fuel, you must complete this section.)
1. Will you transport motor fuel for hire? (Check all that apply.)
For import into Alabama
For export from Alabama
From point to point within Alabama
2. What mode of transportation will you use? (Check all that apply.)
Marine Vessel
Transport Vehicle
Railroad Tank Car
Other _____________________________
O. AVIATION FUEL PURCHASER
An aviation fuel purchaser license is required to purchase aviation fuels at the aviation gasoline and jet fuel rates.
Estimated quantity of fuel purchased from supplier(s) each month:
Aviation Gasoline: ___________________________________      Jet Fuel: ______________________________________
P. STORAGE FACILITY INFORMATION (Attach additional pages if necessary)
Complete the following for motor fuel storage facilities you own and/or lease. (Include facilities that are currently not in use.)
OWN:
TERMINAL CONTROL NUMBER
PHYSICAL LOCATION
HOW WILL MOTOR FUEL
PRODUCT
STORAGE CAPACITY
(IF FUEL IS STORED AT A TERMINAL)
(STREET ADDRESS, CITY, STATE)
BE RECEIVED? (EXPLAIN)
CODE
(GALLONS)
LEASE:
TERMINAL CONTROL NUMBER
PHYSICAL LOCATION
HOW WILL MOTOR FUEL
PRODUCT
STORAGE CAPACITY
(IF FUEL IS STORED AT A TERMINAL)
(STREET ADDRESS, CITY, STATE)
BE RECEIVED? (EXPLAIN)
CODE
(GALLONS)
Q. TAX PRE-COLLECTION AGREEMENT (Permissive Suppliers must complete this section.)
I agree to collect the taxes due to the State of Alabama on Motor Fuel that has Alabama as its destination state and that was removed from a terminal
located in another state.
AUTHORIZED REPRESENTATIVE’S NAME (PLEASE PRINT OR TYPE)
TITLE
AUTHORIZED REPRESENTATIVE’S SIGNATURE
DATE
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
(            )
(            )
R. 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
(            )
(            )
Failure to answer all questions, provide the requested documents or remit the appropriate license fee(s) will constitute cause for rejection of your
application by the Alabama Department of Revenue.
License Fees
Supplier . . . . . . . . . . . . . . . . $200
Importer . . . . . . . . . . . . . . . . . . . $100
Permissive Supplier . . . . . . $    0
Blender . . . . . . . . . . . . . . . . . . . . $    0
Terminal Operator . . . . . . . . $    0
Distributor . . . . . . . . . . . . . . . . . . $  50
Exporter . . . . . . . . . . . . . . . . $100
Aviation Fuel Purchaser . . . . . . $200
Transporter . . . . . . . . . . . . . . $  50
Separate licenses are required for each activity other than a supplier.
FOR OFFICE USE ONLY
Required bond amount $___________________
______________________________________________________________
Manager, Motor Fuels Section
Date
________________________________________
License Number
License(s) will be issued only when bond is posted and approved.