Form B&L: CLGAP "Application for a Compressed Natural Gas/Liquefied Natural Gas License" - Alabama

What Is Form B&L: CLGAP?

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, 2018;
  • 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: CLGAP 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: CLGAP "Application for a Compressed Natural Gas/Liquefied Natural Gas License" - Alabama

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A
D
R
LABAMA
EPARTMENT OF
EVENUE
B
& L
T
D
RESET
B&L: CLGAP
5/18
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 a Compressed Natural Gas/Liquefied Natural Gas License
(THIS APPLICATION DOES NOT CONSTITUTE A LICENSE.)
Under the provisions of Title 40, Chapter 17, Article 3B, Code of Alabama 1975, I hereby make application for a license to engage in the distribution, sale, withdrawal or use of compressed
natural gas (CNG) or liquefied natural gas (LNG) in Alabama, subject to all the laws governing this privilege, and such rules and regulations as may be promulgated by the Alabama Department
of Revenue. If granted a license, I shall, for myself, or for any corporation or agency that I represent, comply with the CNG/LNG excise tax laws in every particular.
APPLICANT’S NAME (AS WILL APPEAR ON PERMIT)
DBA / TRADE NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE
ZIP CODE
SOCIAL SECURITY NUMBER
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 TAX REQUIRES MANDATORY ELECTRONIC FILING OF RETURNS.    Please initial: ______________
COMPLETE THE REVERSE SIDE OF THIS APPLICATION.
Failure to answer all questions, provide the requested documents, or remit the appropriate license fees
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
License will be issued upon approval by Manager.
OFFICE USE ONLY
________________________________    _________________    $________________    ___________________________
APPROVAL
EFFECTIVE DATE
BOND AMOUNT
LICENSE NUMBER
License will be issued only when surety bond is posted and approved.
A
D
R
LABAMA
EPARTMENT OF
EVENUE
B
& L
T
D
RESET
B&L: CLGAP
5/18
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 a Compressed Natural Gas/Liquefied Natural Gas License
(THIS APPLICATION DOES NOT CONSTITUTE A LICENSE.)
Under the provisions of Title 40, Chapter 17, Article 3B, Code of Alabama 1975, I hereby make application for a license to engage in the distribution, sale, withdrawal or use of compressed
natural gas (CNG) or liquefied natural gas (LNG) in Alabama, subject to all the laws governing this privilege, and such rules and regulations as may be promulgated by the Alabama Department
of Revenue. If granted a license, I shall, for myself, or for any corporation or agency that I represent, comply with the CNG/LNG excise tax laws in every particular.
APPLICANT’S NAME (AS WILL APPEAR ON PERMIT)
DBA / TRADE NAME
STREET ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE
ZIP CODE
SOCIAL SECURITY NUMBER
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 TAX REQUIRES MANDATORY ELECTRONIC FILING OF RETURNS.    Please initial: ______________
COMPLETE THE REVERSE SIDE OF THIS APPLICATION.
Failure to answer all questions, provide the requested documents, or remit the appropriate license fees
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
License will be issued upon approval by Manager.
OFFICE USE ONLY
________________________________    _________________    $________________    ___________________________
APPROVAL
EFFECTIVE DATE
BOND AMOUNT
LICENSE NUMBER
License will be issued only when surety bond is posted and approved.
B&L: CLGAP
5/18
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.  Estimated quantity of compressed natural gas (CNG) / liquefied natural gas (LNG) to be distributed, sold, used or withdrawn from
storage each month.
______________________ CNG (GGE) gallons      ______________________ LNG (DGE) gallons
2.  List all CNG/LNG locations in Alabama separately. (Attach additional sheet if needed.)
Physical Address
City
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
3.    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.
4.  Are you purchasing/merging with any organization(s) or person(s) that is/was licensed with the Alabama Department of Revenue?
Yes     
No        If yes, indicate the organization(s) or person(s).
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
(            )
________________________________________________________________________________________________________
License application fee is $50.00 for the first location plus a $25.00 registration fee for each additional location in existence or when
acquired. One license will be issued for all locations.
License Fee Remitted $_________________
Note: A new application will be required if additional stations are acquired.
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