MFT-18
State of New Jersey
2-10
Division of Taxation
MOTOR FUELS TAX
PO Box 189
Trenton, NJ 08695-0189
FUEL CARRIER QUESTIONNAIRE
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-
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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))
5. Mailing Name and Address -
(if different from business address)
3. Trade Name__________________________________________________
Name________________________________________________
4. Business Location:
Street_______________________________________________________
Street________________________________________________
City__________________________________________ State
City___________________________________ State
-
-
Zip Code
Zip Code
(Give 9-digit Zip)
(Give 9-digit Zip)
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. Contact Information: Contact Person ___________________________________________
Title__________________________________
Daytime: (
) _________ - ___________________Ext_________
Evening: (
) _________ - __________________Ext_________
E-Mail Address: _____________________________________________________________________________
9. IF A CORPORATION, complete the following:
Date of Incorp._________/_________/_________
State of Incorp.
month
day
year
10. Provide the following information for the owner, 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 the states your firm operates in, other than New Jersey. (if more space is needed, attach rider).
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
12. Type of petroleum products your firm transports (check appropriate choices):
LS Diesel
Kerosene
Other__________________________________________________
#2 Dyed Diesel
Gasoline
13. Do you solely transport products owned by the company completing this form? . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No