Form Mft-7a - Application For Wholesale Dealer'S License - 1997
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1
2MFT-7A
STATE OF NEW JERSEY
(12-97)
DIVISION OF TAXATION
Application Required by
MOTOR FUEL TAX
NJ Motor Fuel Tax Law
PO BOX 189
Trenton, New Jersey 08646-0189
APPLICATION FOR WHOLESALE DEALER’S LICENSE
Complete this application to request a Wholesale Dealer’s License which is needed for each establishment, wherever located, operated by such person
out of which wholesale sales in New Jersey are made.
Every Wholesale Dealer’s License is subject to payment of a license fee of $450.00 for a three year period which should accompany this application.
Make check or money order payable to: STATE OF NEW JERSEY-MFT
1. FID #
-
OR Soc. Sec. # of Owner
-
-
2. Name ________________________________________________________________________________________________________________
(IF INCORPORATED - give Corp. Name; IF NOT - give Last name, First Name, MI of Owner(s))
3. Trade Name ___________________________________________________________________________________________________________
5. Mailing Name and Address - (if different from business address)
4. Business Location:
Street _____________________________________________________
Name________________________________________________
City_________________________________________ State
Street________________________________________________
-
Zip Code
City____________________________________ State
(Give 9-digit Zip)
-
Zip Code
¨
¨
4a. Business Location:
Owned
Leased
(Give 9-digit Zip)
4b. If leased please provide name and address of owner:
Name ___________________________________________________________________________________________________________________
Address _________________________________________________________________________________________________________________
6. Beginning Date for this business in New Jersey
__________ / __________ / __________
Month
Day
Year
7. Type of Ownership (check one):
¨
¨
¨
¨
¨
NJ Corporation
Sole Proprietor
Partnership
Out-of-State Corporation
Limited Partnership
¨
Other - explain _________________________________________________________________________________________________________
8. Telephone Numbers: Contact Person ______________________________________________
Title _____________________________________
Daytime: (
) _________ - _________________Ext___________
Evening: (
) _________ - _________________Ext__________
9. IF A CORPORATION, complete the following:
Date of Incorp. __________ / __________ / __________
State of Incorp.
Month
Day
Year
10. Provide the following information for ALL owners, partners or responsible corporate officers. (If more space is needed, attach rider).
NAME
HOME ADDRESS
%
SOCIAL SECURITY NUMBER
OWNED
(Last Name, First, M.I.)
TITLE
(Street, City, Zip)
11. List below each location, out of which you sell or use “fuel”. Under type of plant state whether Service Station (S.S.), Storage Tank (S.T.), Bulk Plant
(B.P.) If more than six locations, attach additional sheet giving same information.
Location
Type of Plant
Number of Tanks
Total Capacity of Plant (Gals.)
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