Form Omf-9 - Request For Cancellation Of Terminal Operator'S License
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1Division Use Only — DLN Stamp
Division Use Only — Date Stamp
Requested Date of Cancellation
Send to:
Division of Taxation
PO Box 189
Pursuant to NJSA 54:39-101 et seq
Trenton, NJ 08695-0189
10-2010
Request for
Form OMF-9
Cancellation of Terminal Operator’s License
Attach original license
Name
Address
ID #
Phone #
City, State Zip
Briefly state the reason you are cancelling your license
State the quantity of fuels held in inventory
Gasoline
Diesel
AvGas
Jet Kerosene
Kerosene
LPG
State the disposition of fuels held in inventory. Include name, address, and ID#’s of anyone who received inventory.
State the disposition of the property and business. If sold, state the name, address, and ID# of purchaser or purchasers.
By signing I am acknowledging that this company will cease all activities requiring a Terminal Operator’s License. This
company’s final report is due on the 20
of the month following the date of cancellation. The final Loss Report is due the
th
next February 22
. I understand that in order to effect the cancellation, all outstanding payments must be made and all
nd
outstanding reports must be filed.
Signature – must be signed by owner or corporate officer
Date Signed
Printed Name
Title
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Parent category: Financial