"Application for Marked Gasoline and/or Marked Diesel Oil and Levy Exemption Permit for Fishers" - Prince Edward Island, Canada

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Application for Marked Gasoline and/or
Marked Diesel Oil and Levy Exemption Permit for Fishers
(Pursuant to the Prince Edward Island Gasoline Tax Act, Climate Leadership Act and
Revenue Administration Act R.S.P.E.I. 1988)
Deliver to:
Mail to:
Department of Finance, Taxation and Property Records
95 Rochford Street
PO Box 1150, Charlottetown, PE C1A 7M8
Shaw Building, 1st Floor
Charlottetown, PE C1A 3T7
Tel: (902) 368 4070
Fax: (902) 368 6164
or: any Access PEI Centre
Web Site: www.princeedwardisland.ca
Email: taxandland@gov.pe.ca
Freedom of Information and Protection of Privacy
For Office Use Only:
Personal information on this form is collected under the authority of Section 31(c) of the
Freedom of Information and Protection of Privacy Act and will be used for the purposes
of tax administration and enforcement and may be made available to fuel wholesalers or
the public. Questions on the collection and use of this information can be directed to the
Permit No.: __________________________
Manager, Tax Administration and Compliance Services, PO Box 2000, Charlottetown,
PE C1A 7N8 (902) 368-5137.
Please note: The prescribed issuance fee for marked gasoline and/ or marked diesel oil permit is $10.
The prescribed issuance fee for the levy exemption permit is $10.
Please include payment of $20 with the application.
Section A – General Information
Ownership Type:
Proprietorship
Partnership
Corporation
Full Business Name:
Mailing Address:
Province:
Postal Code:
Civic Address
Province:
Postal Code:
(#/ Street / Suite# or Apt#/ City, Town or Village):
Telephone:
Cell:
Fax:
Email:
Section B – Owner, Partner or Officer Information (If different than Section A)
Name (Full Name Required):
Mailing Address:
Province:
Postal Code:
Civic Address
Province:
Postal Code:
(#/ Street/ Suite# or Apt#/ City, Town or Village):
Telephone:
Cell:
Fax:
Email:
Section C – Business Information
1. Does the business have a HST number or Federal BN ?
Yes
No
If yes, enter either number: __________________
No
Has this business or its owner(s) held a Marked Fuel Permit before?
Yes
2.
If yes, provide the Marked Fuel Permit Number: __________________________________
No If yes, complete the information below ▼
3. Did you purchase an existing fishing operation?
Yes
Date of purchase (mm/yyyy)
Purchased from:
Address:
4. Yearly business operation period:
From: ______________________________
To: _________________________________
5. List the license number(s) and the species of fish caught (attach additional list if required)
.
Number
Species
Number
Species
6. Principal buyer of fish: ________________________________________________________
7. Certified Fisheries Organization Support Fee Paid:
Yes
No
Instructions:
All applications must include proof that the operation is reporting income from the sale of products from
the commercial fishing operation in the name of the applicant.
All core fishers must be in compliance with subsection 8(1) of the Certified Fisheries Organizations
Support Act.
Please Note:
Confirmation of DFO licenses in the name of the applicant must also be attached.
January 2019
Please see reverse
Application for Marked Gasoline and/or
Marked Diesel Oil and Levy Exemption Permit for Fishers
(Pursuant to the Prince Edward Island Gasoline Tax Act, Climate Leadership Act and
Revenue Administration Act R.S.P.E.I. 1988)
Deliver to:
Mail to:
Department of Finance, Taxation and Property Records
95 Rochford Street
PO Box 1150, Charlottetown, PE C1A 7M8
Shaw Building, 1st Floor
Charlottetown, PE C1A 3T7
Tel: (902) 368 4070
Fax: (902) 368 6164
or: any Access PEI Centre
Web Site: www.princeedwardisland.ca
Email: taxandland@gov.pe.ca
Freedom of Information and Protection of Privacy
For Office Use Only:
Personal information on this form is collected under the authority of Section 31(c) of the
Freedom of Information and Protection of Privacy Act and will be used for the purposes
of tax administration and enforcement and may be made available to fuel wholesalers or
the public. Questions on the collection and use of this information can be directed to the
Permit No.: __________________________
Manager, Tax Administration and Compliance Services, PO Box 2000, Charlottetown,
PE C1A 7N8 (902) 368-5137.
Please note: The prescribed issuance fee for marked gasoline and/ or marked diesel oil permit is $10.
The prescribed issuance fee for the levy exemption permit is $10.
Please include payment of $20 with the application.
Section A – General Information
Ownership Type:
Proprietorship
Partnership
Corporation
Full Business Name:
Mailing Address:
Province:
Postal Code:
Civic Address
Province:
Postal Code:
(#/ Street / Suite# or Apt#/ City, Town or Village):
Telephone:
Cell:
Fax:
Email:
Section B – Owner, Partner or Officer Information (If different than Section A)
Name (Full Name Required):
Mailing Address:
Province:
Postal Code:
Civic Address
Province:
Postal Code:
(#/ Street/ Suite# or Apt#/ City, Town or Village):
Telephone:
Cell:
Fax:
Email:
Section C – Business Information
1. Does the business have a HST number or Federal BN ?
Yes
No
If yes, enter either number: __________________
No
Has this business or its owner(s) held a Marked Fuel Permit before?
Yes
2.
If yes, provide the Marked Fuel Permit Number: __________________________________
No If yes, complete the information below ▼
3. Did you purchase an existing fishing operation?
Yes
Date of purchase (mm/yyyy)
Purchased from:
Address:
4. Yearly business operation period:
From: ______________________________
To: _________________________________
5. List the license number(s) and the species of fish caught (attach additional list if required)
.
Number
Species
Number
Species
6. Principal buyer of fish: ________________________________________________________
7. Certified Fisheries Organization Support Fee Paid:
Yes
No
Instructions:
All applications must include proof that the operation is reporting income from the sale of products from
the commercial fishing operation in the name of the applicant.
All core fishers must be in compliance with subsection 8(1) of the Certified Fisheries Organizations
Support Act.
Please Note:
Confirmation of DFO licenses in the name of the applicant must also be attached.
January 2019
Please see reverse
Section D – Fuel Information
1. Provide the following information about your vessels(s) (attach additional list if required).
Name of boat: ______________________________________ Home port: _________________________________
Vessel identification number: __________________________ or Vessel registration number: ___________________
2. List the equipment in which tax exempt fuel is to be used (attach additional list if required).
Type of equipment
Make and model
Horsepower
Fuel type
3. Indicate the estimated annual fuel consumption of equipment listed above.
Gasoline (marked or clear): _________________ litres
Marked diesel oil: ________________ litres
Section E – Certification
I certify that the information contained herein is accurate and complete. I understand that it is an offence, subject to prosecution
under the Revenue Administration Act, to make any false statement(s) on this application. I authorize any inspector under the
Revenue Administration Act to inspect my books and records, vehicles, premises or place where any business is carried on, and to
open any storage tank and remove therefrom any quantity of gasoline or diesel sufficient in their opinion, for the purposes of
determining whether there has been compliance with the Gasoline Tax Act and Climate Leadership Act.
Name (please print)
Title
Signature
Date
Telephone
For Office Use Only
Marked Fuel and Levy Exemption Permit
Comments:
Application Status: Approved:
Gas Only
Both
Denied:
Levy
Both
Approved By: __________________________________
Access Number: _______________________________
Approval Date: ___________ Expiry Date: __________
Updated on: __________________________________
Gasoline Issuance Fee:
Gasoline: $_____ Date Received: ____________ Payment Type: Cash: ____ Cheque: ____ Debit: _____
Received by: ________ Recorded by: ___________
Carbon Issuance Fee:
Levy:
$_____ Date Received: ____________ Payment Type: Cash: ____ Cheque: ____ Debit: _____
Received by: ___________ Recorded by: ___________
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