Form Ap-170-2 - Texas Application For Prepaid Fuels Tax Permit/decal printable pdf download

AP-170-2

(Rev.4-00/3)

TEXAS APPLICATION FOR PREPAID

FUELS TAX PERMIT / DECAL

Page 1.

Please read instructions

• TYPE OR PRINT

• Do not write in shaded areas

For Comptroller use only

1. Legal name of owner (Sole owner, partnership, corporation or other name)

MISCAPP

00991

2. Mailing address (Street & number, P.O. box or rural route and box number)

Tax type

City

State

ZIP code

County

Reference number

3. Enter a daytime phone number (Area code and number ) .........................................................

4. Enter your Social Security Number if you are a sole owner ..............................................................

5. Enter your Federal Employer's Identification (FEI) Number, if any,

assigned by the United States Internal Revenue Service ..................................................................

6. Are you a subsidiary or division of

another company? ................................

YES

If "YES," enter number ........................

7. Do you now have a Taxpayer number

for reporting any Texas tax OR a

Texas Vendor Identification Number? ...

YES

If “YES,” enter number ........................

8. Indicate how your business is owned.

1 - Sole owner

2 - Partnership

3 - Texas corporation

6 - Foreign corporation

7 - Limited partnership

4 - Other (explain) ____________________________________________

9. If your business is a Texas corporation,

Charter number

Charter date

enter the charter number and date ...............................................................

10. If your business is a foreign corporation, enter home state, charter number, Texas Certificate of Authority number and date.

Home state

Charter number

Texas Cert. of Auth. No.

Texas Cert. of Auth. date

11. If your business is a limited partnership,

Home state

Identification number

enter the home state and identification number ......................

If you are a sole owner, skip Item 12.

12. Identification of owners: all general partners or principal corporation officers.

(Attach additional sheets if necessary.)

Name (First, middle initial, last)

Social Security or Federal Employer's Identification (FEI) no.

Title

Home address (Street & number, city, state, ZIP code)

Phone (Area code & number)

Name (First, middle initial, last)

Social Security or Federal Employer's Identification (FEI) no.

Title

Phone (Area code & number)

Home address (Street & number, city, state, ZIP code)

Name (First, middle initial, last)

Social Security or Federal Employer's Identification (FEI) no.

Title

Phone (Area code & number)

Home address (Street & number, city, state, ZIP code)

Name (First, middle initial, last)

Social Security or Federal Employer's Identification (FEI) no.

Title

Phone (Area code & number)

Home address (Street & number, city, state, ZIP code)

Form Ap-170-2 - Texas Application For Prepaid Fuels Tax Permit/decal

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