Free DR-156T - Florida

Florida Temporary Fuel Tax applicaTion

·Importer ·Exporter ·Carrier ·Pollutant

DR-156T R. 03/09
Rule 12B-5.150 Florida Adminisrtative Code Effective 06/09

Florida Temporary Fuel Tax Application

DR-156T R. 03/09

General Information
A person may obtain a temporary importer, exporter, pollutant, or carrier fuel tax license when the Governor of Florida has declared a state of emergency, or when the President of the United States has declared a major disaster in Florida or in any other state or territory of the United States. "Importer" means any person that has met the requirements of s. 206.051, Florida Statutes (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 direct from a terminal rack to a destination outside the state. "Carrier" means every railroad company, pipeline company, water transportation company, private or common carrier, and any other person transporting motor or diesel fuel, casing-head 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. "Florida Pollutant Importer" means any person who imports into or causes to be imported into Florida, taxable pollutants for sale, use, or otherwise. When a state of emergency is declared in Florida, a person may obtain an importer or carrier fuel tax license to import or transport fuel into this state When a major disaster has been declared in any state or territory other than Florida, a person may obtain an exporter or carrier fuel tax license to export or transport fuel to the state or territory where the disaster has been declared. A temporary license will expire on the last day of the month after the month in which a license is issued. A temporary license may be extended for the duration of a declared emergency or major disaster when the licensee makes a written request for such extension.

How many applications do I need?
To import, export, transport, or sell motor or diesel fuel in Florida during a declared state of emergency or major disaster, a person mustfilethisapplicationonlyoncetoengageinsuchbusiness.

How do I file this application?
You must: · Complete the application in its entirety, and · FAXacopyoftheapplicationto(850)922-5938,and · Mailtheoriginalsignedapplicationto: Fuel Unit Florida Department of Revenue P.O.Box6480 Tallahassee,FL32314-6480

Who must file this application?
Any person who seeks to import, export, transport, or sell motor and diesel fuel after the Governor of Florida or the President of the United States has declared a state of emergency or a major disaster.

Remove instructions before returning application.

How do I get more information?
· Forassistancewiththisapplication,call,Mondaythrough Friday,8a.m.to5p.m.,ET,at850-488-4772. · InformationandformsareavailableonourInternetsiteat www.myflorida.com/dor · Forgeneralinformationaboutfueltax,callTaxpayer Services,MondaythroughFriday,8a.m.to7p.m.,ET,at 800-352-3671.Hearingorspeechimpairedpersonsmaycall theTDDat800-367-8331or850-922-1115. NOTE: You are authorized to begin the activity for which your license was issued (importer, exporter, carrier) on the date this application is faxed to the Department

How much is the registration fee?
A registration fee is not required to get a temporary fuel license.

To qualify for a temporary fuel license you must:
· HaveabusinesslocationinFloridaorinanotherstate, and · HaveasalestaxregistrationiflocatedinFlorida,or · HaveaFloridafueltaxlicense,or · HaveafuellicensedissuedinastateotherthanFlorida

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

Florida Temporary Fuel Tax Application

DR-156T R. 03/09

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: WhollyOwnedSubsidiaryofaPubliclyHeld

Corporation

PubliclyHeldCorporation PrivatelyHeldCorporation

B) Partnership (check one):

General Limited Joint Venture SingleMember Multi-member

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

Principal Business Location Address(cannotbeapostofficebox) __________________________________________________ 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.PostalService) Fax No. _______________________________________________ E-mail address _________________________________________

8.

Please check each box that applies to your business activity. Importer Exporter Common Carrier Private Carrier

9.

Address where business records are maintained (cannotbeapostofficebox) _______________________________________ _______________________________________________________________________________________________________________ City ____________________________ County _______________________________ State ____________ ZIP ___________

Country _____________________________________________ 10.

Foreign Postal Code _____________________________________

Mailing address(cannotbeapostofficebox) ______________________________________________________________________ City ____________________________ County _______________________________ State ____________ ZIP ___________

Country _____________________________________________

Foreign Postal Code _____________________________________

11.

Corporation Information A) License Applicant: Date of Incorporation ______________________________________________________________________





Iffilingasacorporation,listthestateinwhichyouareincorporated: ________________________________________________ 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. 12. Personnel/Partner Information: Full name, social security number (SSN), FEIN (if applicable), and address of each corporate officer,owner,generalpartner,stockholderwithacontrollinginterest,and/ordirector.(Makecopiesofthispageifadditional space is needed.) NOTE: Social Security Numbers are used by the Florida Department of Revenue as unique identifiers for the administration of Florida's taxes. Social Security Numbers obtained for tax administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records. A) Name ______________________________________________________ HomeAddress ______________________________________________ City _________________________ Country ________________ SSN FEIN ­ State ____________ ­ ­ (Individual) (Business) ZIP ___________ Ext. ________

County _______________________________

Foreign Postal Code ________________

Phone No. ___________________

Corporate or Business Title _______________________________________________________ Interest/Ownership __________% B) Name ______________________________________________________ HomeAddress ______________________________________________ City _________________________ Country ________________ SSN FEIN ­ State ____________ ­ ­ (Individual) (Business) ZIP ___________ Ext. ________

County _______________________________

Foreign Postal Code ________________

Phone No. ___________________

Corporate or Business Title _______________________________________________________ Interest/Ownership __________% C) Name ______________________________________________________ HomeAddress ______________________________________________ City _________________________ Country ________________ SSN FEIN ­ State ____________ ­ ­ (Individual) (Business) ZIP ___________ Ext. ________

County _______________________________

Foreign Postal Code ________________

Phone No. ___________________

Corporate or Business Title _______________________________________________________ Interest/Ownership __________% D) Name ______________________________________________________ HomeAddress ______________________________________________ City _________________________ Country ________________ SSN FEIN ­ State ____________ ­ ­ (Individual) (Business) ZIP ___________ Ext. ________

County _______________________________

Foreign Postal Code ________________

Phone No. ___________________

Corporate or Business Title _______________________________________________________ Interest/Ownership __________% Page 2 DR-156T R. 03/09

13.

Carrier Information A) Do you transport petroleum products/fuels over the highways and/or waterways of Florida? ............. YES ........... NO If "YES," are you a common carrier? ................................ YES ........... NO .......................... If "NO," go to question 13(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,listthemake/model,year,vehicleidentificationnumber,andtotaltankercapacityofeach 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)

14.

Pollutants Storage Information Will this business import pollutants into this state? .............. YES ........... NO

Licensing Information 15. Are you registered to collect and/or remit sales tax? ..................................................................................... YES NO 16. Will this business import fuels into Florida upon which there has been no precollection of Florida tax? ...... YES NO 17. Doyoutransportpetroleumproductseitherforyourselforforhire? ............................................................. YES NO 18. Doyouexportfuelsfromthisstateotherthanbypipelineormarinevessel? ................................................ YES NO 19. Doyouhaveafuellicenseissuedbyanotherstate?...................................................................................... YES NO IF yes, please provide the state and license number. State ________________ License Number _______________________

Affidavit of Applicant(s) I,theundersignedindividual(s),orifacorporationforitself,itsofficers,anddirectors,herebyswearoraffirmunderpenaltyof perjuryasprovidedinsection837.06,FloridaStatutes,thatIamdulyauthorizedtomaketheforegoingapplicationandthatthe application and all attachments are true and correct representation(s) of the premises to be licensed. If licensed, I agree that the place of business may be inspected and searched, during business hours or at any time business is being conducted on the premises,byofficialsandagentsoftheDepartmentofRevenueforthepurposesofdeterminingcompliancewithChapter206,F.S.
Swornto(oraffirmed)andsubscribedbeforeme State of_____________ County of ________________________________ this ____________ day of ___________________ , ____________ .

_________________________________________________________
Signature of Applicant

__________________________________________
Signature of Notary Public

_________________________________________________________

W A R N I N G :
Read carefully: This instrument is a sworn document. False answers couldresultincriminalprosecutionsubjecttofineand/orimprisonment and denial of your application.

Print or Type Applicant's Name

__________________________________________
Print, Type or Stamp Name of Notary

Personally Known __________orProducedIdentification __________ TypeofIdentificationProduced ___________________________________

DR-156T R. 03/09

Page 3