Application For Transporters License Form - Oklahoma Tax Commission

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9932200
GPR
309-A-R-98
OTX00322-11-98-OK
OKLAHOMA TAX COMMISSION (OTC)
APPLICATION FOR TRANSPORTERS LICENSE
P.O. Box 26920
Oklahoma City, OK 73126-0920
(Please read instructions before completing and print or type information)
Registrant Information
License Fee
$150.00
FEIN/SSN
Company RPTG Number
(includes one cab card)
Additional
Registrant Name (Individual, Partnership, Corporation)
Cab Cards
$ 5.00
Mailing Address (Street and number, post office box, or rural route box)
Please Submit Full
Payment with Application
Business Address (Street and number, post office box, or rural route box)
Expiration Date __________
City
State
Zip
Telephone Number
Transport Information
License Information
Check all that apply
New License
Start Date
A.
Transporting petroleum oil
Renewal
Current Number
B.
Transporting tank bottoms
Change
$5.00 per Card
C.
Transporting pit oil
Cancel
D.
Transporting liquid hydrocarbons
Location
Storage Tanks
(Give specific directions from nearest city or town)
Tank
Tank
Product
County
Number
Capacity
Type
Truck Information:
list all trucks, owned or leased
Unit
Type
License
Trailer
Model
Tag
Vehicle Identification Number
Make
Number
of Truck
Tag Number
Capacity
Year
Year
Please attach schedule if more space is needed on either list above)
I declare under penalty of perjury that to the best of my knowledge the above information is true and correct. I also
understand that I must submit changes when any of the above information changes.
Signature
Title
Date
Office Use Only
License Number
Amount of Surety
Type of Surety
DLN Number
Amount of Fee
Approved by

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