"Application/Renewal for a Gasoline Tax Exemption Permit Under the Revenue Administration Act (For Marked Diesel Only)" - Newfoundland and Labrador, Canada

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Government of Newfoundland and Labrador
Department of Finance
Office of the Comptroller General
Tax Administration Division
Application/Renewal for a Gasoline Tax Exemption Permit Under the Revenue Administration Act
(For Marked Diesel Only)
PLEASE TYPE OR PRINT IN INK WHEN COMPLETING THIS FORM.
<<PLEASE NOTE: Processing Time - Approx 4-6 weeks>>
PERMIT TO BE ISSUED TO
SECTION 1:
NAME AND ADDRESS, AS BELOW
SURNAME
FIRST NAME AND INITIAL
Date of Birth (YYYY MM DD)
INCORPORATED LEGAL NAME (**Attach a Copy of Certificate of Incorporation**)
TRADE NAME -- SAME AS LEGAL
OR:
MAILING ADDRESS
CONTACT PERSON:
SURNAME
POSTAL CODE
FIRST NAME AND INITIAL
TELEPHONE NUMBER
FACSIMILE NUMBER
TELEPHONE NUMBER
FACSIMILE NUMBER
(
)
(
)
(
)
(
)
EMAIL ADDRESS
FEDERAL BUSINESS NUMBER
SECTION 2: FUEL USE CATEGORY - MARKED DIESEL ONLY
Please check appropriate box to indicate in which category fuel will be consumed.
Record only CURRENT License # and Registration # issued in YOUR NAME. DESIGNATION LETTER required if license is not issued in YOUR NAME.
**TO PROCESS YOUR APPLICATION, A COPY OF THE APPLICABLE LICENSE(S), PERMIT(S) AND/OR REGISTRATION(S)
MUST BE SUBMITTED.**
A. Boats and/or vessels used for:
C. Equipment used for the following purposes:
1. Commercial Fishing (Complete Sections 3 and 5)
1. Fish Processing - License No.
2. Commercial Aquaculture - License No.
2. Commercial Farming - Registration No.
3. Collecting and/or delivering fish and/or fishery salt
3. Commercial Sawmill - License No.
(Attach a copy of DFO Collection Permit and/or Fish
4. Commercial Logging - License No.
Transporting License.)
5. Crushing - Quarry Permit No.
6. Other Manufacturing (Attach detailed description of operation)
4. Operating on a regularly scheduled route in interprovincial
or international trade. (Please attach list)
7. Generation of Electricity (Attach detailed description of operation)
8. Mineral exploration and/or pre-production of a mine
B. Equipment owned or operated by:
9. Petroleum Exploration Site
An Incorporated Municipality
D.
If you are employed by a commercial wood harvesting company or contractor, please supply the name of the company and the identification
number issued to you by that company. ______________________________________________________________________________________
E.
If you are using fuel in more than one category, please indicate in which category you will use the most fuel. ______________________________
________________________________________________________________________________________________________________________
SECTION 3: COMMERCIAL FISHING
1. Fisher Identification Number (F.I.N. #):
2. How many diesel powered boats/vessels with a C.F.V. Number are you using for fishing? __________
(If you have auxiliary boats not registered or other equipment, list them in item 4 below, by motor type and size, and specify what the boat or
equipment is used for.)
3. List all C.F.V. boats/vessels being used for fishing, along with related information. Attach a list if space is insufficient.
**A copy of the applicable License(s) and/or Registration(s) is required.**
C.F.V. NUMBER
Length of Boat
Make of Motor
Horsepower
(Section 3 continued on next page)
Government of Newfoundland and Labrador
Department of Finance
Office of the Comptroller General
Tax Administration Division
Application/Renewal for a Gasoline Tax Exemption Permit Under the Revenue Administration Act
(For Marked Diesel Only)
PLEASE TYPE OR PRINT IN INK WHEN COMPLETING THIS FORM.
<<PLEASE NOTE: Processing Time - Approx 4-6 weeks>>
PERMIT TO BE ISSUED TO
SECTION 1:
NAME AND ADDRESS, AS BELOW
SURNAME
FIRST NAME AND INITIAL
Date of Birth (YYYY MM DD)
INCORPORATED LEGAL NAME (**Attach a Copy of Certificate of Incorporation**)
TRADE NAME -- SAME AS LEGAL
OR:
MAILING ADDRESS
CONTACT PERSON:
SURNAME
POSTAL CODE
FIRST NAME AND INITIAL
TELEPHONE NUMBER
FACSIMILE NUMBER
TELEPHONE NUMBER
FACSIMILE NUMBER
(
)
(
)
(
)
(
)
EMAIL ADDRESS
FEDERAL BUSINESS NUMBER
SECTION 2: FUEL USE CATEGORY - MARKED DIESEL ONLY
Please check appropriate box to indicate in which category fuel will be consumed.
Record only CURRENT License # and Registration # issued in YOUR NAME. DESIGNATION LETTER required if license is not issued in YOUR NAME.
**TO PROCESS YOUR APPLICATION, A COPY OF THE APPLICABLE LICENSE(S), PERMIT(S) AND/OR REGISTRATION(S)
MUST BE SUBMITTED.**
A. Boats and/or vessels used for:
C. Equipment used for the following purposes:
1. Commercial Fishing (Complete Sections 3 and 5)
1. Fish Processing - License No.
2. Commercial Aquaculture - License No.
2. Commercial Farming - Registration No.
3. Collecting and/or delivering fish and/or fishery salt
3. Commercial Sawmill - License No.
(Attach a copy of DFO Collection Permit and/or Fish
4. Commercial Logging - License No.
Transporting License.)
5. Crushing - Quarry Permit No.
6. Other Manufacturing (Attach detailed description of operation)
4. Operating on a regularly scheduled route in interprovincial
or international trade. (Please attach list)
7. Generation of Electricity (Attach detailed description of operation)
8. Mineral exploration and/or pre-production of a mine
B. Equipment owned or operated by:
9. Petroleum Exploration Site
An Incorporated Municipality
D.
If you are employed by a commercial wood harvesting company or contractor, please supply the name of the company and the identification
number issued to you by that company. ______________________________________________________________________________________
E.
If you are using fuel in more than one category, please indicate in which category you will use the most fuel. ______________________________
________________________________________________________________________________________________________________________
SECTION 3: COMMERCIAL FISHING
1. Fisher Identification Number (F.I.N. #):
2. How many diesel powered boats/vessels with a C.F.V. Number are you using for fishing? __________
(If you have auxiliary boats not registered or other equipment, list them in item 4 below, by motor type and size, and specify what the boat or
equipment is used for.)
3. List all C.F.V. boats/vessels being used for fishing, along with related information. Attach a list if space is insufficient.
**A copy of the applicable License(s) and/or Registration(s) is required.**
C.F.V. NUMBER
Length of Boat
Make of Motor
Horsepower
(Section 3 continued on next page)
SECTION 3: COMMERCIAL FISHING (continued)
4. If you have additional equipment or auxillary boats not registered that may qualify for tax exempt marked diesel, please list below,
indicating what each is used for. (Do not include motors in boats that are listed in item 3 above.) Attach a list if space is insufficient.
MAKE AND TYPE
Horsepower
Equipment Usage
SECTION 4: EQUIPMENT (OTHER THAN FISHING)
1. List equipment that may qualify for tax exempt marked diesel below, indicating what each is used for.
(Do not include motors in boats that are listed in Section 3 above.) Attach a list if space is insufficient.
MAKE AND TYPE
Horsepower
Equipment Usage
<<Fisher's license(s) must be in applicant's name in order to be eligible for a 3 year permit>>
SECTION 5: FEES
Fee Paid:
1 year - $120
2 year - $240
3 year - $360
Cash
Cheque
Money Order
Visa
MasterCard
Method of Payment:
Expiry Date:
Credit Card Number:
Signature:
**Please make cheque/money order payable to: Newfoundland Exchequer**
SECTION 6: CERTIFICATION
I hereby certify that the information contained in this application is correct to the best of my knowledge and belief.
NAME (Please Print)
TITLE
SIGNATURE
DATE
Privacy and Confidentiality Notice
This information is collected for the purpose of the Department of Finance to process applications under the Revenue Administration Act. All
information you provide, both personal and business related, will be kept confidential and compliant with the Access to Information and
Protection of Privacy Act, 2015 (
www.assembly.nl.ca/Legislation/sr/statutes/a01-2.htm
). If you have any questions regarding privacy and
confidentiality please contact the Tax Administration Division toll free at 1-877-729-6376.
Completed applications and enquiries may be directed to the address below:
Department of Finance
Tax Administration Division
Confederation Building, 3rd Floor, East Block
P.O. Box 8720
St. John's NL A1B 4K1
Telephone: 1-877-729-6376
Fax: (709) 729-2856
Email: taxadmin@gov.nl.ca
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