Form Sfn 22944 - Application For Special Fuel Tax License
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1
2Application For Special Fuel Tax License
Tax Type 56
North Dakota Office of State Tax Commissioner
SFN 22944 (6-1999)
All information must be complete and accurate
Section 1: License fees
Submit a license fee of $20.00 payable to the State Tax Commissioner.
Section 2: Information about your business
1. Name (business, corporate, or legal) as it should appear on your license ___________________________________________
____________________________________________________________________________________________________
2. Check every category below which applies to your business. (Review the definitions.)
Terminal Operator
Supplier
Importer
Retailer
Refiner
Distributor
Exporter
3. If you are an importer, list the states and provinces from which you plan to import fuel ________________________________
____________________________________________________________________________________________________
4. If you are an exporter, list the states and provinces to which you plan to export fuel __________________________________
____________________________________________________________________________________________________
5. Check the type of special fuel your North Dakota activities will include:
Clear Diesel
Clear Kerosene
Heating Fuel
Other - Specify ______________
Dyed Diesel
Dyed Kerosene
Compressed Natural Gas
6. On what date should your license become effective? ___________________________________________________________
7. How many business sites in North Dakota do you intend to operate under this license? ____________
8. Estimate the number of gallons of special fuel you intend to sell in North Dakota on a monthly basis.
_______________
9. List your anticipated special fuel suppliers or distributors.
Name of supplier/distributor
Address (or location where fuel will come from)
10. How do you plan to transport the special fuel to your place of business or to your North Dakota customer?
Railroad Tank Car
Truck
Pipeline
Other
- Specify ____________________________
If by truck, do you own your own trucks?
Yes
No
If no, list the names of the carriers who will do the hauling for you. _______________________________________________
____________________________________________________________________________________________________
Please Do Not Write In This Space
Approved by: ______________________
Date _____________
______________________
Date _____________
License no.
______________________
Date issued
______________________
Date canceled ______________________
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Parent category: Financial