Form REG-8-A Application for Motor Fuel Tax License (Distributor, Supplier, Receiver, and/Or Blender) - Illinois

Form REG-8-A is a Illinois Department of Revenue form also known as the "Application For Motor Fuel Tax License (distributor, Supplier, Receiver, And/or Blender)". The latest edition of the form was released in June 1, 2018 and is available for digital filing.

Download an up-to-date Form REG-8-A in PDF-format down below or look it up on the Illinois Department of Revenue Forms website.

Step-by-step Form 8-A instructions can be downloaded by clicking this link.

ADVERTISEMENT
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
REG-8-A
Application for Motor Fuel Tax License
(Distributor, Supplier, Receiver, and/or Blender)
Step 1: Identify your business or organization
8
Check the organization type that applies to you:
1
Federal employer identification number (FEIN)
q
Proprietorship
FEIN: ______ - __________________
____ Check if owned by a married couple or civil union
Proprietorships must provide the Social Security number (SSN)
q
q
Partnership
Trust or estate
under which taxes will be filed.
*
*
q
q
Corporation
S Corp (Subchapter S Corporation)
SSN: _________ - ______ - ____________
*
Is your corporation publicly traded? ___ Yes
___ No
2
Legal business name:
If yes, provide the ticker symbol ____________
__________________________________________________
q
q
Governmental unit
Not-for-profit organization
3
Doing-business-as (DBA), assumed, or trade name, if different
q
q
LLC - Corporation
LLC - Partnership
from Line 2:
q
LLC - Single member ____ Check if disregarded
__________________________________________________
9
State of incorporation: _________
4
Primary or legal business address:
Date of incorporation:
______ / ______ / ______
__________________________________________________
10
Is your business part of a unitary group? ___ Yes
___ No
Street address - No PO Box number
Apartment or suite number
If “Yes”, provide the FEIN of your designated agent
________________________________________________
(the entity responsible for filing your Illinois income tax return):
City
State
ZIP
FEIN: ______ - __________________
5
Mailing address if different from the address above:
11
Identify a contact person regarding your business.
__________________________________________________
Name: __________________________ Title: _____________
In-care-of name
__________________________________________________
Phone: (______) ______ - ________
Ext.: _____________
Street address or PO Box number
Apartment or suite number
Email address: ______________________________________
__________________________________________________
Note: If the person identified above is not an employee or officer,
City
State
ZIP
Form IL-2848, Power of Attorney, must be attached to this
6
Location of books and records:
application.
12
Owner and officer information:
__________________________________________________
q
Street address
Apartment or suite number
Complete and attach Schedule REG-8-O, Owner and
__________________________________________________
Officer Information
City
State
ZIP
13
Responsible party information:
7
Business website:
q
Complete and attach Schedule REG-8-R, Responsible
Party Information
__________________________________________________
Step 2: Out-of-state business information (If you are not an out-of-state business, go to Step 3.)
q
q
14
Are you registered in Illinois as a foreign corporation? Yes
No
If “Yes”, provide your Illinois Secretary of State identification number:
___ - ___ ___ ___ ___ - ___ ___ ___ - ___
If “No”, contact the Illinois Secretary of State to determine if you must register as a foreign corporation.
15
Illinois agent information (if you are an out-of-state applicant, you must identify an Illinois agent):
q
Complete and attach Form RMP-14, Designation and Appointment of Agent
Step 3: Business information
16
Is your business now (or has your business ever been) associated with any other corporation, company, or individual which has (or had)
q
q
an interest in the sale or distribution of motor fuels/other fuels? Yes
No
If “Yes”, provide the following information (attach additional sheets, if necessary):
Name of individual: ___________________________________
SSN:
_________ - ______ - ____________
Name of business: ___________________________________
FEIN:
______ - __________________
Motor Fuel License number: ________________________
Page 1 of 4
REG-8-A (R-06/18)
Use your mouse or Tab key to move through the fields. Use your mouse or space bar to enable check boxes.
Illinois Department of Revenue
REG-8-A
Application for Motor Fuel Tax License
(Distributor, Supplier, Receiver, and/or Blender)
Step 1: Identify your business or organization
8
Check the organization type that applies to you:
1
Federal employer identification number (FEIN)
q
Proprietorship
FEIN: ______ - __________________
____ Check if owned by a married couple or civil union
Proprietorships must provide the Social Security number (SSN)
q
q
Partnership
Trust or estate
under which taxes will be filed.
*
*
q
q
Corporation
S Corp (Subchapter S Corporation)
SSN: _________ - ______ - ____________
*
Is your corporation publicly traded? ___ Yes
___ No
2
Legal business name:
If yes, provide the ticker symbol ____________
__________________________________________________
q
q
Governmental unit
Not-for-profit organization
3
Doing-business-as (DBA), assumed, or trade name, if different
q
q
LLC - Corporation
LLC - Partnership
from Line 2:
q
LLC - Single member ____ Check if disregarded
__________________________________________________
9
State of incorporation: _________
4
Primary or legal business address:
Date of incorporation:
______ / ______ / ______
__________________________________________________
10
Is your business part of a unitary group? ___ Yes
___ No
Street address - No PO Box number
Apartment or suite number
If “Yes”, provide the FEIN of your designated agent
________________________________________________
(the entity responsible for filing your Illinois income tax return):
City
State
ZIP
FEIN: ______ - __________________
5
Mailing address if different from the address above:
11
Identify a contact person regarding your business.
__________________________________________________
Name: __________________________ Title: _____________
In-care-of name
__________________________________________________
Phone: (______) ______ - ________
Ext.: _____________
Street address or PO Box number
Apartment or suite number
Email address: ______________________________________
__________________________________________________
Note: If the person identified above is not an employee or officer,
City
State
ZIP
Form IL-2848, Power of Attorney, must be attached to this
6
Location of books and records:
application.
12
Owner and officer information:
__________________________________________________
q
Street address
Apartment or suite number
Complete and attach Schedule REG-8-O, Owner and
__________________________________________________
Officer Information
City
State
ZIP
13
Responsible party information:
7
Business website:
q
Complete and attach Schedule REG-8-R, Responsible
Party Information
__________________________________________________
Step 2: Out-of-state business information (If you are not an out-of-state business, go to Step 3.)
q
q
14
Are you registered in Illinois as a foreign corporation? Yes
No
If “Yes”, provide your Illinois Secretary of State identification number:
___ - ___ ___ ___ ___ - ___ ___ ___ - ___
If “No”, contact the Illinois Secretary of State to determine if you must register as a foreign corporation.
15
Illinois agent information (if you are an out-of-state applicant, you must identify an Illinois agent):
q
Complete and attach Form RMP-14, Designation and Appointment of Agent
Step 3: Business information
16
Is your business now (or has your business ever been) associated with any other corporation, company, or individual which has (or had)
q
q
an interest in the sale or distribution of motor fuels/other fuels? Yes
No
If “Yes”, provide the following information (attach additional sheets, if necessary):
Name of individual: ___________________________________
SSN:
_________ - ______ - ____________
Name of business: ___________________________________
FEIN:
______ - __________________
Motor Fuel License number: ________________________
Page 1 of 4
REG-8-A (R-06/18)
17
Are any officers, directors, or partners of your business now (or have any officers, directors, or partners of your company ever been) associated
with any other corporation, company, or individual which has (or had) an interest in the sale or distribution of motor fuels/other fuels?
q
q
Yes
No
If “Yes”, provide the following information (attach additional sheets, if necessary):
Name of individual: ___________________________________
SSN:
_________ - ______ - ____________
Name of business: ___________________________________
FEIN:
______ - __________________
Motor Fuel License number: ________________________
18
List all motor fuel/other fuel license numbers held by your business, from your home state and all other states (attach additional sheets, if
necessary):
State
Gasoline license number
Special fuel license number
Other license number
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
Step 4: Business activities
19
Estimate the number of gallons handled monthly in Illinois:
Gasoline ________________ Special Fuel ________________ Dyed Diesel ________________ Other Fuels
________________
(specify)
20
Describe in detail all of your intended monthly motor fuel/fuel operations in Illinois once licensed (attach additional sheets, if necessary):
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
21
If you have previously held a motor fuel license in Illinois, describe in detail the changes to the operations of your business which require
you to reapply for a new Illinois license (attach additional sheets, if necessary):
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
q
q
22
Will you import motor fuel or other fuels into Illinois? Yes
No
If “Yes”, how often will you import?
______________________________
List all products you will import: ____________________________________________________________________________________
List all states you will import from: _________________________________________________________________________________
q
q
23
Will you export motor fuel or other fuels from Illinois? Yes
No
If “Yes”, how often will you export?
______________________________
List all products you will export: ____________________________________________________________________________________
List all states you will export to: ____________________________________________________________________________________
24
Provide the following information for all your suppliers of motor fuel and/or other fuels (attach additional sheets, if necessary):
Business name
Phone
(______) ______ - ________
___________________________________________________________
Business address
___________________________________________________________
Type of Transport*
Location of receipt (city and state)
Carrier owned/hired by you or supplier
Select one:
Select one:
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
*
Tank car, Truck, Barge, Pipeline, Other-specify
REG-8-A (R-06/18)
Page 2 of 4
Business name
Phone
(______) ______ - ________
___________________________________________________________
Business address
___________________________________________________________
Type of Transport*
Location of receipt (city and state)
Carrier owned/hired by you or supplier
Select one:
Select one:
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
*
Tank car, Truck, Barge, Pipeline, Other-specify
Business name
Phone
(______) ______ - ________
___________________________________________________________
Business address
___________________________________________________________
Type of Transport*
Location of receipt (city and state)
Carrier owned/hired by you or supplier
Select one:
Select one:
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
q
q
q
q
_____________
__________________________
Owned
Hired
You
Supplier
*
Tank car, Truck, Barge, Pipeline, Other-specify
q
q
25
Do you lease Illinois bulk storage tanks/space to another company?
Yes
No
If “Yes”, attach a copy of your contract.
Name of lessee:
______________________________________________________
Volume leased: ______________________________________________________
q
q
26
Do you lease Illinois bulk storage tanks/space from another company? Yes
No
If “Yes”, attach a copy of your contract.
Name of lessor:
______________________________________________________
Volume leased: ______________________________________________________
27
List the Illinois bulk storage tanks/space you operate. List each storage tank separately (attach additional sheets, if necessary):
Location
Product Type*
Storage Capacity
Above or below ground
Owned or leased
(street, city, and state)
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
*Gas - Gasoline; GHL - Gasohol; DSL - Diesel; DD - Dyed Diesel; KER - Kerosene; AVI - Aviation/jet fuel; 1-K - 1-K Kerosene; Other - specify
28
List the Illinois retail outlets you own or operate. List each retail outlet separately (attach additional sheets, if necessary):
Location
Product Type*
Storage Capacity
Above or below ground
Owned or leased
(street, city, and state)
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
q
q
q
q
_____________________________________ _____________ _______________________
above
below
owned
leased
*Gas - Gasoline; GHL - Gasohol; DSL - Diesel; DD - Dyed Diesel; KER - Kerosene; AVI - Aviation/jet fuel; 1-K - 1-K Kerosene; Other - specify
q
q
29
Do you own fuel transport trucks? Yes
No
If “Yes”, how many? _______
q
q
Do you own tank wagons?
Yes
No
If “Yes”, how many? _______
IFTA license number
Base jurisdiction
_______________________
________
q
q
Will you sell aviation fuel at retail? Yes
No
Page 3 of 4
REG-8-A (R-06/18)
Step 5: Blending activities
30
Will you blend, compound, or manufacture motor fuel/other fuels?
q
q
Blend
Yes
No
q
q
Compound
Yes
No
q
q
Manufacture Yes
No
If you answered “Yes” to any of the above, complete the rest of Step 5. Otherwise, go to Step 6.
31
If you will blend with alcohol, give the name(s) of your alcohol supplier(s):
___________________________________________________
If you will blend with soy, give the name(s) of your soy supplier(s):
___________________________________________________
32
Tell us whether the only activity with respect to motor fuel/other fuels is:
q
Production of alcohol in quantities of less than 10,000 proof gallons per year
q
Blending alcohol in quantities of less than 10,000 proof gallons per year
33
Estimate the number of gallons of motor fuel to be blended, compounded, or manufactured monthly:
Gasoline ________________ Special Fuel ________________ Dyed Diesel ________________ Other Fuels
________________
(specify)
34
Estimate the number of gallons of blending agent(s) to be blended, compounded, or manufactured monthly:
Alcohol/Ethanol __________ Soy/Biodiesel _______________ 1-K ______________________ Other
____________________
(specify)
35 Give a detailed description of the products to be used for blending, compounding, or manufacturing:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
36 Give a detailed description of the process to be used for blending, compounding, or manufacturing:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
37 Identify the location and equipment used for blending, compounding, or manufacturing:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
38 What do you intend to do with the blended, compounded, or manufactured product(s)?
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Step 6: Sign below
I understand that I am not authorized to act as a distributor or blender of motor fuel, supplier of special fuel, or receiver of fuel in the state of Illinois
until this application has been approved by the Illinois Department of Revenue and I receive a valid Motor Fuel Tax license for that purpose.
Under penalties of perjury, I state that I have examined this information and, to the best of my knowledge, it is true, correct, and complete.
Signature:
_______________________________________
Title:
________________________
Date: ___/___/______
Printed name:
_______________________________________
Phone: (______) ______ - _________
ALCOHOL TOBACCO AND FUEL DIVISION
Mail your completed form with any
ILLINOIS DEPARTMENT OF REVENUE
required attachments to:
PO BOX 19467
SPRINGFIELD IL 62794-9467
If you have questions, email us at REV.MF@illinois.gov or call us weekdays between 8:00 a.m. and 4:00 p.m. at 217 782-2291.
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this information is required. Failure
to provide information may result in this form not being processed and may result in a penalty. Printed by the authority of the State of Illinois (web only-1).
REG-8-A (R-06/18)
Page 4 of 4
Reset
Print
ADVERTISEMENT
Page of 4