Form YG602 "Fuel Oil Tax - Application 2" - Yukon, Canada

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F.O.T. APPLICATION 2
FUEL OIL TAX ACT
Section 12 (2) Fuel Oil Vendor Licence Information
1. Name of Applicant (legal name of business organization, proprietor or partners)
_____________________________________________________________________________________________
2. Registered Trade Name — if applicable (Doing Business As)
_____________________________________________________________________________________________
3a. Business Location ___________________________________________________________________________
3b. Mailing Address _____________________________________________________________________________
4. Accounting Office Address ____________________________________________________________________
5. Type of Ownership:
Corporation
Registered Association
Partnership
Individual Proprietor
6. Owners: If Corporation, names of officers; if Partnership, names of partners.
Title
Name
Address
_________________________
_______________________
________________________________________
_________________________
_______________________
________________________________________
_________________________
_______________________
________________________________________
I, _____________________________________________, ______________________________________________
(Name - Please Print)
(Title - Please Print)
as a duly authorized officer of ______________________________________________________________________
(Company Name - Please Print)
hereby CERTIFY that the information contained in this application is correct to the best of my knowledge and belief and
hereby make application as required under the Fuel Oil Tax Act and undertake to comply with the provisions of this Act
and the Regulations thereunder.
______________________________________________
_______________________________
Date
Signature
_______________________________
__________________________________________________
Date
Signature
(If the applicant is a corporation, the application shall be under SEAL of the Corporation. If a partnership, signatures of all partners are required.)
Prepare in duplicate for EACH LOCATION requiring a licence pursuant to the Act. Return original to the:
Deputy Head
Department of Finance
Government of Yukon
PO Box 2703
Phone: (867) 667-5345
Whitehorse, Yukon Y1A 2C6
Fax:
(867) 456-6709
YG(602EQ)F2 04/2013
F.O.T. APPLICATION 2
FUEL OIL TAX ACT
Section 12 (2) Fuel Oil Vendor Licence Information
1. Name of Applicant (legal name of business organization, proprietor or partners)
_____________________________________________________________________________________________
2. Registered Trade Name — if applicable (Doing Business As)
_____________________________________________________________________________________________
3a. Business Location ___________________________________________________________________________
3b. Mailing Address _____________________________________________________________________________
4. Accounting Office Address ____________________________________________________________________
5. Type of Ownership:
Corporation
Registered Association
Partnership
Individual Proprietor
6. Owners: If Corporation, names of officers; if Partnership, names of partners.
Title
Name
Address
_________________________
_______________________
________________________________________
_________________________
_______________________
________________________________________
_________________________
_______________________
________________________________________
I, _____________________________________________, ______________________________________________
(Name - Please Print)
(Title - Please Print)
as a duly authorized officer of ______________________________________________________________________
(Company Name - Please Print)
hereby CERTIFY that the information contained in this application is correct to the best of my knowledge and belief and
hereby make application as required under the Fuel Oil Tax Act and undertake to comply with the provisions of this Act
and the Regulations thereunder.
______________________________________________
_______________________________
Date
Signature
_______________________________
__________________________________________________
Date
Signature
(If the applicant is a corporation, the application shall be under SEAL of the Corporation. If a partnership, signatures of all partners are required.)
Prepare in duplicate for EACH LOCATION requiring a licence pursuant to the Act. Return original to the:
Deputy Head
Department of Finance
Government of Yukon
PO Box 2703
Phone: (867) 667-5345
Whitehorse, Yukon Y1A 2C6
Fax:
(867) 456-6709
YG(602EQ)F2 04/2013
VENDOR PERMIT APPLICATION - PAGE 2
1. Have you ever had a Yukon Fuel Vendor’s permit before? yes no
If yes, under what name and what location?_______________________________________________________
__________________________________________________________________________________________
Do you still require this permit? yes no
2. Please give your operating name if it is different from your business name.
___________________________________________________________________________________________
3. What is your operating season? from ________________________ to _____________________________
4. Who is your major supplier? ___________________________________________________________________
Are you under contract with them? yes no
Do you hold their fuel on consignment? yes no
5. Which trucking company transports your fuel for you? ________________________________________________
___________________________________________________________________________________________
6. How are fuel deliveries verified? _________________________________________________________________
___________________________________________________________________________________________
7. Do you also sell tobacco products at this place of business? yes no
If yes, what is your Tobacco Retailer’s Permit Number? _______________________________________________
8. Do you sell heating fuel? yes no
If yes, do you deliver? yes no
9. Please give the name and number of the person to contact in case of inquiries.
Name ______________________________________________________________________________________
Phone __________________________ Fax ________________________ Email __________________________
For Department Use Only
Permit No. ___________________ Date Issued _______________________
Authorized
(for initial) _______________________________________________________________________
The personal information requested on this form is collected under the authority of and used for the purpose of administering the Fuel Oil Tax Act.
Questions about the collection or use of this information can be directed to the Yukon Department of Finance, Box 2703, Whitehorse, Yukon, Y1A 2C6,
(867) 667-5343.
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