Form Dmf-9 - Request For Cancellation Of Distributor Of Motor Fuels License

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Division 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 DMF-9
Cancellation of Distributor of Motor Fuels License
Attach original license
Name
Address
ID #
Phone #
Address
Check the type(s) of license held
City, State Zip
Importing
Exporting
Blending
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 Distributor of Motor Fuels License. This
company’s final report is due on the 20
of the month following the date of cancellation. I understand that in order to
th
effect the cancellation, all outstanding payments must be made and all outstanding reports must be filed.
Signature – must be signed by owner or corporate officer
Date Signed
Printed Name
Title

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