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Get mfa 1 2021-2024

You blend Fuels List the types of fuels you blend and the blendstocks used. You sell Aviation Fuel. You must file a separate MFA-1 for each retail establishment. The applicant agrees to provide accurate and timely reports and to make timely payments. Inaccurate or incomplete information in any section is cause for denial of the requests made in Section 15 or 16 and/or the denial of the entire application. New Jersey Form MFA-1 Instructions Complete all appropriate sections and remit this to State of New Jersey LMF to Be sure to check whether this is an Initial Change or changes of Address Activity etc check Change. Division use only DLN Stamp Send to Rev 12-2013 New Jersey Division of Taxation PO Box 189 Trenton NJ 08695-0189 Combined Motor Fuels License Application Form MFA-1 Initial Application Change Application Renewal Application Section 1 Business Information Federal ID Number IRS 637 Number New Jersey Tax ID Number Does your company internet access Business Name Webpage Address Trade Name Phone Number have Yes No Fax Number Physical Address Mailing Address Books and Records Address Hours of Operation Mon. -- Tues. Wed* Thur. Fri. Sat. Sun* Section 2 Contact Information If you wish to give an attorney or accountant access to your tax information you must supply us with an Appointment of Taxpayer Representative Form Form M-5008-R giving us the authority to release confidential information to them* Contact for Registration Title Telephone No Email Address Contact for Reporting Site Manager Individual Completing this Form Section 3 Prior Owner Information Complete if you are purchasing an existing business. Former Business Name Former License Number Former Phone Number City State Zip Date Ownership Transferred Date Former Business Ended Section 4 Type of Ownership Sole Proprietorship may include spouse Limited Liability Partnership New Jersey Corporation Date of Incorporation Partnership Government Entity Out-of-State Corporation State Date Registered in New Jersey Limited Partnership Trust Other specify Section 5 Owner Information Provide information for sole proprietor all partners or principal officers of corporations or limited liability corporations attach rider if necessary. Name Last First M Social Security Number Home Address Section 6 Relationships with Other Organizations Information regarding persons affiliated with this business who either are also affiliated or have been affiliated with another business that requires licensing under NJSA 54 39-101 et. seq. attach rider if necessary. Individual s Name Title with Applicant Name of Business with which Affiliation Exists Affiliated Business FID Address of Business with which Affiliation Exists Date Joining Applicant Effective Date of Title Check each type of product with which you will be dealing in New Jersey. Gasoline Gasohol Fuel Grade Alcohol Other List each other product LPG Undyed Diesel Dyed Kerosene Dyed Biodiesel Aviation Fuel Check all that apply. Supplier of Motor Fuels You are registered or required to be registered pursuant to Section 4101 of the Federal Internal Revenue Code of 1986 and one or more of A through E* A.

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