Form CVO-06 Diesel Dealer/Distributor License Application - Vermont

Form CVO-06 or the "Diesel Dealer/distributor License Application" is a form issued by the Vermont Department of Motor Vehicles.

The form was last revised in October 1, 2016 and is available for digital filing. Download an up-to-date Form CVO-06 in PDF-format down below or look it up on the Vermont Department of Motor Vehicles Forms website.

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Diesel Dealer/Distributor License Application
120 State Street
DEPARTMENT OF MOTOR VEHICLES
Montpelier, Vermont 05603-0001
Agency of Transportation
dmv.vermont.gov
Voice 802.828.2070
Fax 802.828.3577
1. In accordance with the provisions of 23 V.S.A. §3005, application is hereby made for licensing as a:
Dealer: Retail Seller to Motor Vehicles
Distributor: Seller of Low Sulfur Diesel to Bulk storage of dealers or users
2. Federal ID Number:
____________________
3. Name of Applicant:
__________________________________
4. Mailing Address:
____________________________________
____________________________________
5. Location of Business:
____________________________________
____________________________________
6. Name, Title & Contact information of Person Responsible for Preparing Diesel Tax Reports:
Name:
Phone (1):
________________________________
________________________________
Title:
Phone (2):
________________________________
________________________________
Email:
Fax:
________________________________________
________________________________
7. Diesel Pumps – Number Of Pumps At This Location:
_____________
8. Diesel Fuel Tanks: Number Of Tanks And Tank Capacity At This Location:
Number of Tanks:
_________
Tank Capacity:
_________
9. From who do You Purchase Your Diesel Fuel?
Name:
____________________
Address: _____________________________________________
10. ACH Payments will be accepted if your diesel tax liability exceeds $50,000.00 a month. Please contact this
Department for further information and the necessary paperwork.
Continues On Reverse
CVO-06 10/2016 MTC
Diesel Dealer/Distributor License Application
120 State Street
DEPARTMENT OF MOTOR VEHICLES
Montpelier, Vermont 05603-0001
Agency of Transportation
dmv.vermont.gov
Voice 802.828.2070
Fax 802.828.3577
1. In accordance with the provisions of 23 V.S.A. §3005, application is hereby made for licensing as a:
Dealer: Retail Seller to Motor Vehicles
Distributor: Seller of Low Sulfur Diesel to Bulk storage of dealers or users
2. Federal ID Number:
____________________
3. Name of Applicant:
__________________________________
4. Mailing Address:
____________________________________
____________________________________
5. Location of Business:
____________________________________
____________________________________
6. Name, Title & Contact information of Person Responsible for Preparing Diesel Tax Reports:
Name:
Phone (1):
________________________________
________________________________
Title:
Phone (2):
________________________________
________________________________
Email:
Fax:
________________________________________
________________________________
7. Diesel Pumps – Number Of Pumps At This Location:
_____________
8. Diesel Fuel Tanks: Number Of Tanks And Tank Capacity At This Location:
Number of Tanks:
_________
Tank Capacity:
_________
9. From who do You Purchase Your Diesel Fuel?
Name:
____________________
Address: _____________________________________________
10. ACH Payments will be accepted if your diesel tax liability exceeds $50,000.00 a month. Please contact this
Department for further information and the necessary paperwork.
Continues On Reverse
CVO-06 10/2016 MTC
11. In accordance with 32 V.S.A. §3113, are you in good standing with respect to, or in full compliance with a plan
approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this
application?
YES
NO
If not, you must do one of the following before a new license or renewal of license will be issued:
a. Arrange with the Vermont Department of Taxes to bring yourself into good standing by contacting the
Director of Compliance, Vermont Department of Taxes at (802) 828-2821 or 109 State Street, Montpelier,
VT 05609-1401.
b. Seek a determination through a hearing process that immediate payment of taxes due and payable would
impose an unreasonable hardship upon you. You may request a hearing by contacting the AOT Hearings
Division at (802) 828-2016 or at the National Life Records Building, Drawer 33, Montpelier, VT 05633-5001.
12. In accordance with 15 V.S.A. §795, are you in good standing with respect to or in full compliance with a plan to
pay any and all child support payable under a support order as of the date this application is signed?
YES
NO
A license will not be issued or renewed without full compliance with the above. Please direct any questions
to the Vermont Office of Child Support at 800-768-3214.
Distributors are required to submit a bond to this office before such a license will be issued. This office will supply
you with the bond application and the required bond amount. Such bond should cover the period when business is
st
started in Vermont until December 31
of that year or an entire calendar year. Bonds must be renewed annually as
provided by 23 V.S.A. 3102. Under penalties of perjury, the undersigned hereby certifies that the information given
on this form is true, correct and complete to the best of his/her knowledge and belief.
If the applicant is an individual or partnership, then the owner must sign. If the applicant is a corporation, the
corporate officer who is responsible for the collection and payment of taxes must sign. If a person other than the
ones whose signature appears below becomes responsible for this reporting, the Department of Motor Vehicles
must be notified at once.
I certify that the statement herein is true. This declaration made under the penalties of 23 V.S.A. Subsection 202.
Printed Name
Title
FIN, SSN or License #
Signature
Date
Department Use Only
Issue Date:
License #:
Effective/Renewal Date:
Approved By:

Download Form CVO-06 Diesel Dealer/Distributor License Application - Vermont

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