Ap 197 Form – Fill Out and Use This PDF

The AP-197 form, officially known as the Texas Dyed Diesel Fuel End User Signed Statement Number Registration, is a necessary document for entities in Texas seeking to purchase tax-free dyed diesel fuel for off-highway use. This form is required for a range of entities, including sole owners, partnerships, corporations, and other organizations, provided they are located in Texas and intend to issue a signed statement to their suppliers or distributors for the purchase of this specific type of fuel without the tax. Individuals and organizations must obtain an End User Number from the Comptroller's office to complete the process. For those looking to complete this essential documentation for tax-free fuel purchasing, clicking the button below will guide you through the filling out of the AP-197 form.

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Ap 197 Form PDF Details

Understanding the nuances of fuel use and taxation can be quite complex, especially for businesses and organizations that operate in specific industries. In the state of Texas, entities looking to purchase tax-free dyed diesel fuel for off-highway use must navigate through the process of obtaining an End User Signed Statement Number Registration, as outlined in the AP-197 form. This form serves as a critical tool for sole owners, partnerships, corporations, and various other organizations located within Texas wishing to use dyed diesel fuel without incurring the state's fuel tax, provided the fuel is used for specific off-highway purposes. The comprehensive guidelines stipulated by the Texas Comptroller of Public Accounts include the submission requirements, such as providing detailed business information, understanding the type of business entity involved, and clarifying the primary use of the dyed diesel fuel whether for agricultural, non-agricultural, or oil and gas production purposes. Relevant contact details, along with federal privacy act notifications, making this form a significant step in adhering to Texas's tax regulations while ensuring that businesses can operate effectively within the legal framework. By following the specific instructions laid out on the form, businesses can submit their application through various means, aiming to streamline the administrative process while upholding the integrity of tax management and environmental conservation efforts within the state.

Question	Answer
Form Name	Ap 197 Form
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	form ap 197, texas dyed diesel permit, texas diesel fuel, texas dyed diesel permit search

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Texas Dyed Diesel Fuel End User

Signed Statement Number Registration

G L E N N H E G A R T E X A S C O M P T RO L L E R O F P U B L I C AC C O U N T S

GENERAL INFORMATION

Who Must Submit This Registration - You must submit this registration if you are a sole owner, partnership, corporation or other

organization; you are located in Texas; and you want to purchase tax-free dyed diesel fuel for off-highway use by issuing a signed statement to your supplier or distributor. You must obtain an End User Number from the Comptroller’s ofice.

For Assistance - If you have any questions regarding this registration, iling tax returns or any other tax-related matter, you may contact the Texas State Comptroller’s ield ofice in your area or call 1-800-252-1383.

You can submit your completed application by mail, fax, or email:

Mail:	Texas Comptroller of Public Accounts	FAX: (512) 936-0012
	111 E. 17th St.	Email: FuelsTax@cpa.texas.gov
	Austin, TX 78774-0100

We process applications in the order they are received. If you have questions or need more information, contact us at 800-252-1383.

Federal Privacy Act - Disclosure of your Social Security number is required and authorized under law, for the purpose of tax admin- istration and identiication of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of information on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government Code, and applicable federal law.

You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct information we have on ile

about you. Contact us at the address or phone numbers listed on this form.

SPECIFIC INSTRUCTIONS

Item 1 - Sole Owner: Enter the irst name, middle initial and last name.

Item 4 - Other Organization: Explain the type of organization. Examples: Social Club, Independent School District, Family Trust.

Item 5 - Partnership: Enter the legal name of the partnership.

Corporation: Enter the legal name exactly as it is registered with the Secretary of State.

Other Organization: Enter the title of the organization.

Items 3 & 6 - If you have both a Texas taxpayer number and a Texas Identiication Number, enter the irst 11 digits of the Texas Iden- tiication Number.

Item 7 - Enter the Federal Employer Identiication Number (FEIN) assigned to your business by the Internal Revenue Service.

Item 9 - Enter the complete mailing address where you wish to receive mail from the Comptroller of Public Accounts. If you wish to receive mail at a different address for other taxes, attach a letter with the other addresses.

Item 13 - Texas Corporation: Enter the ile number assigned by the Secretary of State and date of formation.

Item 14 - Foreign Corporation (chartered out of Texas): Enter the state or country of formation, the charter/ile number and date, and the Texas Secretary of State ile number and date.

Item 16 - Limited Partnership: Enter the state in which the partnership is registered and the limited partnership number issued by the Secretary of State.

Item 17 - Partnership: Enter information for all partners.

If the applicant does not have a Social Security number, enter the Individual Taxpayer Identiication Number (ITIN) or other number assigned by the federal government for use when iling federal income tax returns.

Corporation or Other Organization: Enter information for the principal oficers (president, vice-president, secretary).

Item 19 - Enter the actual location of your business—street address or meaningful directions. Example: “3 miles south of FM 1960

on Jones Road.” Do not use a P.O. Box or Rural Route number.

AP-197-1 (Rev.6-18/14)

AP-197-2

(Rev.6-18/14)

Texas Dyed Diesel Fuel End User

Signed Statement Number Registration

AP19720W061814
AP19720W061814
* A P 1 9 7 2 0 W 0 6 1 8 1 4 *
• Type or print in ink. • Do not write in shaded areas.	Page 1

SOLE OWNER IDENTIFICATION

Name of sole owner (First, middle initial and last name)

Social Security number (SSN)

3. Taxpayer number for reporting any Texas tax OR Texas Identiication

Check here if you DO NOT

Number if you now have or

have a SSN.

have ever had one.

NON-SOLE OWNER IDENTIFICATION

4. Business organization type

--- ALL SOLE OWNERS SKIP ITEMS 4 - 8 ---

Texas registered limited liability partnership (PX)

Non-Texas registered limited liability partnership (PY)

General partnership (PB, PI) Limited partnership (PL or PF)

Other (explain)

	Texas limited liability company (CL)		Non-Texas limited liability company (CI)
	Texas proit corporation (CT)		Non-Texas proit corporation (CF)
	Texas proit corporation (CT)		Non-Texas proit corporation (CF)
	Texas nonproit corporation (CN)		Non-Texas nonproit corporation (CM)
	Texas nonproit corporation (CN)		Non-Texas nonproit corporation (CM)

Trust (FM or TR) (Please submit a copy of the trust agreement with this application.)

Estate (ES)

Professional corporation (CP) Professional association (AP)

5.Legal name of partnership, company, corporation, association, trust or other (Do not list DBA.)

6.Taxpayer number for reporting any Texas tax or Texas Identiication Number if you now have or have ever had one

7.Federal Employer Identiication Number (FEIN) assigned by the Internal Revenue Service ...............................................

8. Check here if you do not have a FEIN . ......................................................................................................................... ....

BUSINESS INFORMATION

TAXPAYER INFORMATION

Mailing address

Street number, P.O. Box or rural route and box number

City

State/province

ZIP code

County (or country, if outside the U.S.)

10.

Name of person to contact regarding day to day business operations

Daytime phone

11.

Principal type of business

Agriculture

Transportation

Retail Trade

Real Estate

Mining

Communications

Finance

Services

Construction

Utilities

Insurance

Public Administration

Manufacturing

Wholesale Trade

Other (explain)

12.

Primary business activities and type of products or services to be sold

SIC

If you are a SOLE OWNER, skip Items 13 - 17.

13. If the business is a Texas proit entity, nonproit entity, professional entity

File number

Month Day

Year

or limited liability company, enter the ile number and date

14. If the business is a non-Texas proit entity, nonproit entity, professional entity or limited liability company, enter the state or country of formation, charter/ile number and date, Texas Secretary of State ile number and date.

State/country of formation Charter/ile numberMonth Day YearTexas Secretary of State ile number Month Day Year

15.	.......If the business is a entity, have you been involved in a merger within the last seven years?	YES	NO	(If “YES,” attach a detailed explanation.)
16.	If the business is a limited partnership or registered limited liability		State		Number
16.
	partnership, enter the home state and registered identiication number

17.General partners, principal members/oficers, managing directors or managers (ALL GENERAL PARTNERS MUST BE LISTED - Attach additional sheets, if necessary.)

Name

Title

Phone (Area code and number)

Home address

City

State

ZIP code

SSN or ITIN

Percent of

Driver license number

State

County (or country, if outside the U.S.)

ownership

________

Position held

Partner

Oficer

Director

Corporate stockholder

Record keeper

Name

Title

Phone (Area code and number)

Home address

City

State

ZIP code

SSN or ITIN

Percent of

Driver license number

State

County (or country, if outside the U.S.)

ownership

________

Position held

Partner

Oficer

Director

Corporate stockholder

Record keeper

AP-197-3

(Rev.6-18/14)

Texas Dyed Diesel Fuel End User

Signed Statement Number Registration

AP19730W061814
AP19730W061814
* A P 1 9 7 3 0 W 0 6 1 8 1 4 *
• Type or print in ink. • Do not write in shaded areas.	Page 2

18.Legal name of entity (Same as Item 1 OR Item 5)

LOCATION	19. Business location name and address (Attach additional sheets for each additional location.)
LOCATION		Business location name
		Business location name


		Street and number (Do not use P.O. Box or rural route)	City
BUSINESS
BUSINESS		Physical location of your business in Texas or physical location where performing a contract in Texas
		(If business location address is a rural route and box number, provide directions.)

SSN or FEIN

State	ZIP code	County

Business location phone

20. Fuel use type (Check only one.)

DD• An End User Signed Statement Number authorizes the tax-free purchase of only dyed diesel fuel for use in off-highway equipment operated in Texas for non-agricultural purposes. Non-agricultural purposes include diesel fuel used by construction companies (road, commercial buildings or residential), manufacturers (forklifts, loaders, welding machines, space heaters or generators), commercial trucking companies or excavating companies (land clearing or mowing services). Non-agricultural also consists of agricultural cooperatives, associations, cotton gins, farm supply stores, tractor supply stores, feed stores or veterinary services.

Will the dyed diesel fuel be used in oil and gas production?

YES

•

The dyed diesel fuel is consumed to start initial production or increase production on the formation. Oil and gas production consists of fracturing

(frac job), perforating, squeeze cement, workover, acidizing, logging, drilling deeper, plug back, completion, plug and abandon, pulling or resetting casing liner, installing a casing liner, drilling out a plug, putting on artiicial lift (new installation), running a bottom hole bomb, swabbing, jetting,

gravel packing and hot oil treatment of formation. Oil and gas production does not consist of companies that perform maintenance (set units, mow around unit and tank batteries, paint unit and tank batteries, and gauge tanks), pump changes, rod or tubing jobs, ishing for rods or tubing, repair tubing leak, change packer or anchor, hot oil or water treatment of casing, tubing or low lines, marketers, speculators or transportation com- panies. (EXCEPTION: A purchaser that uses an End User Signed Statement Number to purchase dyed diesel fuel for its exclusive use in oil or gas production must also furnish a Letter of Exception issued by the Comptroller that authorizes the purchase of up to 25,000 gallons per month.)

An End User Signed Statement Number for agricultural users authorizes the tax-free purchase of only dyed diesel fuel for exclusive use in agricultural off-highway equipment operated in Texas, such as a tractor or combine, on a farm or ranch. A farm or ranch is one or more tracts of land used, either in whole or in part, in the production of crops, livestock and/or other agricultural products held for sale in the regular course of business.

A feed lot, livestock auction facility, dairy farm, poultry farm, commercial orchard, commercial nursery, timber operation or similar commercial

agricultural operation is a farm or ranch. Timber operations include the production of timber including land preparation, planting, maintenance and gathering of trees commonly grown for commercial timber. Wildlife management is agricultural use as deined by the Texas Tax Code, 23.51(7).

A home garden is not a farm or ranch. An agricultural non-highway purpose does not include the processing, packaging or marketing of agricul- tural products by anyone other than the original producer. (EXCEPTION: An agricultural purchaser that uses an End User Signed Statement Number is authorized to purchase up to 25,000 gallons per month.)

21. How many diesel-powered on-road motor vehicles do you own?
22. Do you maintain bulk storage in Texas?	YES	NO
22. Do you maintain bulk storage in Texas?	YES	NO
[Bulk storage is deined as a container of more than 10 gallons. (Tex. Tax Code Ann. Sec. 162.001)]

23. Will all dyed diesel fuel be used in off-highway equipment in Texas?	YES	NO
	YES	NO

SIGNATURES

24.The sole owner, all general partners, corporation or organization president, vice-president, secretary or treasurer, managing director or an authorized representative must sign. A representative must submit a written power of attorney. (Attach additional sheets, if necessary.)

I (We) declare that:

(1)all of the dyed diesel fuel purchased on a signed statement will be consumed by the purchaser and will not be resold;

(2)none of the dyed diesel fuel purchased on a signed statement will be delivered or permitted to be delivered into the fuel supply tanks of motor vehicles operating on the public highways in this state; and

(3)I will not make purchases in excess of 10,000 gallons per month.

If any of the statements above are not true, you do not qualify to buy dyed diesel fuel in Texas on a Signed Statement. You may apply for a Dyed Diesel Fuel Bonded User License.

I am aware that certain ines and criminal penalties are provided by law for providing false information in obtaining a dyed diesel fuel End User Signed Statement Number.

I (We) further declare that the information in this document and any attachments is true and correct to the best of my

(our) knowledge and belief.

Month Day

Year

Type or print name and title of sole owner, partner or oficer

Sole owner, partner or oficer

Type or print name and title of partner or oficer

Partner or oficer

Type or print name and title of partner or oficer

Partner or oficer

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Ap 197 Form – Fill Out and Use This PDF

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