Free DR 156 R. 01-05.indd - Florida


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FLORIDA FUEL TAX APPLICATION

· Terminal Operator · Terminal Supplier · Wholesaler · Importer · Exporter · Blender · Carrier · Mass Transit · Local Government · Retailer of Alternative Fuels · Pollutant

DR-156 R. 01/05

Florida Fuel Tax Application Information
Who must register?
Businesses storing, delivering or selling fuel, other than at retail, must have a license under Chapter 206, Florida Statutes (F.S.). This application must be completed by any person engaging in or conducting business involving fuel in the State of Florida who is required to hold one or more of the following licenses: "Wholesaler" means any person who holds a valid wholesaler of taxable fuel license issued by the Department of Revenue. "Importer" means any person who has met the requirements of s. 206.051, F. S., and is licensed by the Department to import motor fuel or diesel fuel upon which no precollection of tax has occurred, other than through bulk transfer, into this state by common carrier or company-owned trucks. "Exporter" means any person who has met the requirements of s. 206.052, F.S., and who is licensed by the Department as an exporter of taxable motor or diesel fuels either from substorage at a bulk facility or directly from a terminal rack to a destination outside the state. "Local Government User of Diesel Fuel" means any county, municipality, or school district licensed by the Department to use untaxed or dyed diesel fuel in motor vehicles. "Mass Transit System" means any licensed local transportation company providing local bus service that is open to the public and travels regular routes. "Terminal Operator" means any person who owns, operates, or otherwise controls a terminal. A terminal operator may own the motor or diesel fuel that is transferred through or stored in the terminal, but must be licensed as a terminal supplier. "Terminal Supplier" means any position holder who has been licensed by the Department as a terminal supplier, has met the requirements of ss. 206.05 and 206.90, F.S., and is registered under s. 4101 of the Internal Revenue Code for transactions involving the bulk storage and transfer of taxable motor or diesel fuels. "Carrier" means every railroad company, pipeline company, water transportation company, private or common carrier, and any other person transporting motor or diesel fuel, casinghead gasoline, natural gasoline, naphtha, or distillate for others, either in interstate or intrastate commerce, to points within Florida, or from a point in Florida to a point outside the state. "Retailer of Alternative Fuel" means any person who sells alternative fuel at retail for use in non-Florida registered motor vehicles. "Blender" means any person who produces blended diesel fuel outside the bulk transfer/terminal system.

DR-156 R. 01/05

How much is the registration fee?
The application fee for a wholesaler of alternative fuel is $5. There is no fee for a local government user of diesel fuel or mass transit system. The fee for each of the other license categories is $30.

Where do I file this application and required fee(s)?
Mail this application with the required fee(s) and the applicable surety bond(s) to: CENTRAL REGISTRATION ­ FUEL UNIT FLORIDA DEPARTMENT OF REVENUE PO BOX 6480 TALLAHASSEE FL 32314-6480

Do not send cash.

Are there additional fees?
· · Certain applicants are required to undergo a background investigation. The cost will be billed to the applicant. Most applicants are also required to post a bond in an amount equal to three times the monthly tax liability.

Remove instructions before returning applica-

When do I begin filing tax returns?
Tax returns must be filed monthly, beginning with the month your business opens. A return must be filed even if no tax was collected.

What if I am already doing business and have not applied?
The business owner should immediately cease operating and contact Central Registration to properly register and make arrangements to calculate and remit any taxes or penalties due.

When do I need to contact the Department of Revenue?
· · · To file this application. · If you move. If you close your business. · If you need assistance. If you change or add a · If you change your contact licensable business activity. person.

How do I get more information?
· For assistance with this application, call Central Registration, Monday through Friday, 8 a.m. to 5 p.m., ET, at 850-488-4772. Information and forms are available on our Internet site at www.myflorida.com/dor For general information about fuel tax, call Taxpayer Services, Monday through Friday, 8 a.m. to 7 p.m., ET, at 800-352-3671 or 850-488-6800. Hearing or speech impaired persons may call the TDD line at 800-367-8331 or 850-922-1115.

· ·

How many applications do I need?
A business entity is an activity or group of activities operating under one Federal Employer Identification Number (FEIN). Those entities with more than one fuel activity may apply for different license classifications on one application.

W A R N I N G :
It is a third degree felony to operate without a license.

Florida Fuel Tax Application

DR-156 R. 01/05

1. 2. 3. 4. 5.

Federal Employer Identification Number (FEIN)

FEIN

­

Business Name _____________________________________________________ Phone No. _______________________ Trade Name, D.B.A. or A.K.A. __________________________________________ Fax No. __________________________ Contact Person _____________________________________________________ Phone No. _____________ ext. _____ Type and Legal Organization: (Please check only one) A) Corporation (check one): C Corp S Corp If corporation, check any of the appropriate boxes that apply: Wholly Owned Subsidiary of a Publicly Held Corporation

Publicly Held Corporation Privately Held Corporation B) Partnership (check one):

General Limited Joint Venture Single Member Multi-member

C) Limited Liability Company (check one): D) Individual/Sole Proprietorship E) Business Trust F) Governmental Agency 6.

Principal Business Location Address (cannot be a post office box) _____________________________________________ City _________________________ County ____________________________ State ___________ ZIP __________

Country ________________________________________ 7.

Foreign Postal Code _________________________________

How would your company like to receive information on Florida fuel tax? (Please check one) Mail Fax E-mail (U.S. Postal Service) Fax No. __________________________________________ E-mail address _____________________________________

8.

Please check each box that applies to your business activity. Terminal Operator Exporter Mass Transit System Terminal Supplier Blender Retailer of Alternative Fuel Wholesaler Common Carrier Importer Private Carrier

Local Government User of Diesel Fuel YES NO

9.

A) Do you operate or otherwise control a terminal?

B) If "YES," state the number of terminals:___________________ and complete the following information for each terminal location address you operate. Each terminal location requires a separate $30.00 terminal license fee. (If necessary, attach additional sheets.) Terminal Location Address _______________________________________________________________________________ City ____________________________ State _________ ZIP ____________ Phone No. _____________________

Terminal Location Address _______________________________________________________________________________ City ____________________________ State _________ ZIP ____________ Phone No. _____________________

Terminal Location Address _______________________________________________________________________________ City ____________________________ State _________ ZIP ____________ Phone No. _____________________

10.

Address where business records are maintained (cannot be a post office box) ___________________________________ ____________________________________________________________________________________________________ City _________________________ County ____________________________ State ___________ ZIP __________

Country ________________________________________ 11.

Foreign Postal Code _________________________________

Mailing address (cannot be a post office box) _______________________________________________________________ City _________________________ County ____________________________ State ___________ ZIP __________

Country ________________________________________ 12. Corporation Information A) License Applicant:

Foreign Postal Code _________________________________

Date of Incorporation ________________________________________________________________

If filing as a corporation, list the state in which you are incorporated: ____________________________________________ List other states where your corporation has operated or is operating: __________________________________________ B) Parent Corporation (if applicable) Parent Corporation FEIN ­

Parent Corporation Name _____________________________________________________________________________ Parent Corporation Address ___________________________________________________________________________ City _______________________ Country ______________ County ____________________________ State ___________ ZIP __________ Ext. _______

Foreign Postal Code ______________

Phone No. _________________

NOTE: If incorporated in a state other than Florida, you must attach a certified copy of the certificate or license issued by the Florida Secretary of State authorizing the corporation to transact business in Florida. 13. Personnel/Partner Information: Full name, social security number (SSN), FEIN (if applicable), and address of each corporate officer, owner, general partner, stockholder with a controlling interest, and/or director. (Make copies of this page if additional space is needed.) A) Name_________________________________________________ Home Address__________________________________________ City _______________________ Country ______________ SSN FEIN ­ State ___________ ­ ­ (Individual) (Business) ZIP __________ Ext. _______

County ____________________________

Foreign Postal Code ______________

Phone No. _________________

Corporate or Business Title __________________________________________________ Interest/Ownership _________ % B) Name_________________________________________________ Home Address__________________________________________ City _______________________ Country ______________ SSN FEIN ­ State ___________ ­ ­ (Individual) (Business) ZIP __________ Ext. _______

County ____________________________

Foreign Postal Code ______________

Phone No. _________________

Corporate or Business Title __________________________________________________ Interest/Ownership _________ % C) Name_________________________________________________ Home Address__________________________________________ City _______________________ Country ______________ SSN FEIN ­ State ___________ ­ ­ (Individual) (Business) ZIP __________ Ext. _______

County ____________________________

Foreign Postal Code ______________

Phone No. _________________

Corporate or Business Title __________________________________________________ Interest/Ownership _________ % Page 2 DR-156 R. 01/05

D) Name_________________________________________________ Home Address__________________________________________ City _______________________ Country ______________

SSN FEIN ­

­

­

(Individual) (Business) ZIP __________ Ext. _______

County ____________________________

State ___________

Foreign Postal Code ______________

Phone No. _________________

Corporate or Business Title __________________________________________________ Interest/Ownership _________ % NOTE: Certain persons listed above may be mailed fingerprint cards and may be subject to a background investigation. Publicly held corporations must submit federal Form 1OK or their most recent annual report documenting publicly held status. 14. Carrier Information A) Do you transport petroleum products/fuels over the highways and/or waterways of Florida? .............. YES ........... NO .......................... If "NO," go to question 15. If "YES," are you a common carrier?................................. YES ........... NO .......................... If "NO," go to question 14(B) If "YES," what mode of transportation is used to transport the fuel/petroleum products? Truck Rail Vessel Pipeline

B) If you are not a common carrier, list the make/model, year, vehicle identification number, and total tanker capacity of each truck, barge, boat, or other equipment used to transport fuel on the highways or waterways of Florida. Cab cards will be issued for each motor vehicle or item of equipment used to transport fuel. (If necessary, attach a separate sheet.) Make/Model Year Vehicle ID Number Tanker Capacity (in Gallons)

15.

Fuel Storage Information A)

Answer all questions. DO NOT leave any blank.

1.) Do you have a through-put agreement? ................................................ YES .................. NO 2.) Do you deliver fuel directly to retail locations? ...................................... YES .................. NO 3.) Do you own, operate or lease any bulk storage tanks in Florida? ........ YES .................. NO If "YES" to 3, list all below and indicate whether it is owned or leased: Tank Capacity (in Gallons) *DEP Number Physical Location (Address) Own/Lease

* "DEP number" means the facility identification number assigned by the Florida Department of Environmental Protection to your location. (If necessary, attach a separate sheet.)

DR-156 R. 01/05

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15.

Pollutants Storage Information B) Will this business produce, import, or remove petroleum pollutants through a terminal rack in this state? YES If "YES" (check appropriate box(es)): Produce Import or cause to be imported (into Florida) Ammonia Crude Oil Export Chlorine Perchloroethylene Be entitled to a refund on the following taxable pollutants: Petroleum Products Pesticides Solvents Motor Oil or Other Lubricants NO.

Other (specify) __________________________________________________________________________

List the type of pollutant, location of storage facility, and estimated volume of taxable units imported, produced, or sold in Florida. Type of Pollutant Location of Storage Facility Taxable Units

16.

Bond Information A) The license categories shown below usually require a bond. Please complete the information as it applies to your business to determine the bond(s) you must obtain. FUEL Terminal Supplier Wholesaler Importer Exporter
1 E.A.M.G. - Estimated Average Monthly Gallons. 2 Bonds are not required for local government users, 3 Use

Motor E.A.M.G.1 Bond Amount2 E.A.M.G.1

Diesel Bond Amount2

Aviation E.A.M.G.1 Bond Amount2

mass transit systems, carriers, terminal operators, or blenders. If a bond is required, it must be sent to the Central Registration Fuel Unit before your application can be processed. estimated average daily gallons to be imported, instead of estimated average monthly gallons.

16.

Pollutants B) The pollutants bond is calculated based on the three (3) times the average monthly pollutants tax paid or due during the preceding 12 calendar months, if you are already in business. If you are a new registrant, your bond amount will be three (3) times your projected monthly tax liability. The projection will depend on the quantity and tax rate of the pollutant you produce or import during an average month. Your bond will not exceed $100,000 and no bond is required if your three month tax liability is less than $50. Average Monthly Pollutants Tax ____________ x 3 = ______________________ A surety bond for the amount calculated above should be enclosed with the application. An assigned time deposit or an irrevocable letter of credit may be accepted in lieu of a bond.

17.

List all suppliers of pollutants. Name of Supplier License Number

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DR-156 R. 01/05

Licensing Information 18. Do you sell alternative fuel at retail for use in motor vehicles? ------------------------------------------------------------ YES NO 19. A) Do you wholesale motor, diesel, or aviation fuel? ----------------------------------------------------------------------- YES NO B) If "YES," do you have (or have you applied for) a wholesaler license? ----------------------------------------- YES NO 20. Are you a county, municipality, or school district that uses untaxed diesel fuel in motor vehicles? -------------- YES NO 21. Are you a mass transit system providing local bus service that is open to the public and travels regular routes? ------------------------------------------------------------------------------------------------------------------------ YES NO 22. A) Do you have a valid refund permit number? ----------------------------------------------------------------------------- YES NO B) If "YES," what is your refund permit number? ---------------------------------------------------------------------------23. A) Do you own or operate any motor vehicles powered by alternative fuels in Florida? ------------------------ YES NO B) If "YES," do you have the required alternative fuel decal(s)? -------------------------------------------------------- YES NO C) If "YES," what is your account number? ----------------------------------------------------------------------------------24. A) Are you registered to collect and/or remit sales tax? ------------------------------------------------------------------ YES NO B) If "YES," what is your sales tax registration number? -----------------------------------------------------------------25. Will this business import fuels into Florida upon which there has been no precollection of Florida tax? ------- YES NO 26. A) Are you registered as a Position Holder under section 4101 of the Internal Revenue Code for transactions involving the storage and transfer of motor and/or diesel fuel(s)? -------------------------------- YES NO B) If "YES," what is your federal fuel registration number? --------------------------------------------------------------27. Do you blend products for use as motor fuel, diesel fuel, or aviation fuel? -------------------------------------------- YES NO 28. Do you transport petroleum products either for yourself or for hire? ----------------------------------------------------- YES NO 29. Do you sell alternative fuel at wholesale? -------------------------------------------------------------------------------------- YES NO 30. If you are applying for a wholesaler license, do you request authority to make deferred fuel tax payments to your supplier by electronic funds transfer? ---------------------------------------------- YES NO 31. Do you export fuels from this state other than by pipeline or marine vessels? ---------------------------------------- YES NO 32. Do you have any other outstanding tax liability with the Department of Revenue? ---------------------------------- YES NO 33. Have you or other owners, officers, directors, or stockholders with a controlling interest, been convicted of, or entered a plea of guilty or nolo contendere to, a felony committed against the laws of any state or the United States?--------------------------------------------------------------------------- YES NO 34. Blender Information A) Do you produce biodiesel fuel from vegetable or animal oils or fats? ---------------------------------------------- YES NO B) Do you import biodiesel fuel into Florida? --------------------------------------------------------------------------------- YES NO C) Do you blend biodiesel fuel with petroleum diesel? --------------------------------------------------------------------- YES NO D) Do you sell biodiesel fuel or biodiesel blends? --------------------------------------------------------------------------- YES NO 35. Do you sell aviation fuel at retail for any purpose other than directly into the fuel tank of an airplane? --------- YES NO 36. A) Do you own or operate retail stations that sell gasoline, diesel fuel, or aviation fuel posted at retail prices? ---------------------------------------------------------------------------------------------- YES NO B) If yes, how many locations do you own or operate? -------------------------------------------------------------------- _____________ Affidavit of Applicant(s) I, the undersigned individual(s), or if a corporation for itself, its officers, and directors, hereby swear or affirm under penalty of perjury as provided in sections 659.791, 562.45, and 837.06, Florida Statutes, that I am duly authorized to make the foregoing application, and hereby swear or affirm that the application and all attachments are true and correct representation(s) of the premises to be licensed and agree that the place of business, if licensed, may be inspected and searched during business hours or at any time business is being conducted on the premises without a search warrant by officials and agents of the Department of Revenue, for purposes of determining compliance with the Florida fuel laws.
Sworn to (or affirmed) and subscribed before me State of ___________ County of ____________________________ this ____________ day of _________________, __________ .

___________________________________________________
Signature of Applicant

______________________________________
Signature of Notary Public

___________________________________________________
Print or Type Applicant's Name

W A R N I N G :
Read carefully: This instrument is a sworn document. False answers could result in criminal prosecution subject to fine and/or imprisonment and denial of your application.

______________________________________
Print, Type or Stamp Name of Notary

Personally Known _________ or Produced Identification ________ Type of Identification Produced _______________________________

DR-156 R. 01/05

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DR-156 R. 01/05