Mfa 1 Form PDF Details

The world of motor fuel distribution and retail in New Jersey is meticulously regulated to ensure compliance, safety, and tax accuracy, culminating in the requirement for entities to navigate through the application and maintenance of licenses via the Combined Motor Fuels Form MFA-1. This document serves a multi-purpose role, catering to diverse business needs such as initial licensing, changes to existing licenses, and renewals. The form requires detailed business information including identification numbers, addresses, and contact details, ensuring that entities are easily reachable and verifiable. Importantly, it also mandates the disclosure of relationships with other organizations, mirroring the state's intent to maintain a transparent record of business affiliations that might affect license integrity. Moreover, the MFA-1 form is critical for specifying the types of motor fuels handled, including but not limited to gasoline, kerosene, and various biofuels, alongside the specific business activities undertaken by the licensee. Each section of the form meticulously gathers information pertinent to regulatory compliance, from the types of products dealt with, to detailed owner information, showcasing the state's rigorous approach to oversee the motor fuel industry's operations within its borders. Whether for suppliers, distributors, retailers, or transporters of motor fuels, this form acts as a gateway to legal operation in New Jersey's motor fuel sector, laden with responsibilities including the payment of application fees and adherence to the stipulations enclosed within.

QuestionAnswer
Form NameMfa 1 Form
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namesstamp fuels application print, dln nj license, nj motor fuels tax, mfa 1 year

Form Preview Example

Divisio n use o nly – DLN Sta m p

Divisio n use o nly – Da te Sta m p

 

SE ND TO :

RE V 9-2021

Ne w Je rse y Divisio n o f Ta xa tio n

PO BO X 189

TRE NTO N, NJ 08695-0189

C o m b ine d Mo to r Fue ls

Fo rm MFA - 1

Lic e nse A p p lic a tio n

 

 

Initial Application

 

 

Change Application

 

 

Renewal Application

Activity Start Date for Initial Applications ___________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 1 – Business Information

 

 

 

 

Federal ID Number

IRS 637 Number

New Jersey Tax ID Number

Web Address

 

 

 

 

 

 

 

 

 

 

 

Business Name

 

 

 

 

Phone Number

 

 

 

 

 

 

 

 

 

 

 

Trade Name

 

 

 

 

Email Address

 

 

 

 

 

 

 

 

 

 

 

Physical Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Books and Records Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 Number

Email Address

Contact for Reporting

Title

Telephone Number

Email Address

Individual Completing this Form

Title

Telephone Number

Email Address

Section 3 – Information on Prior License Holder (Retailer’s Only)

Complete for initial applications only

Former Business Name

Former License Number

Former Phone Number

 

 

 

Former Business Address

City, State, Zip

Date New Business Started

 

 

 

Former Business Mailing Address

City, State, Zip

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, Middle)

Title

Social Security Number

 

 

 

Home Address

Home Phone Number

Cell Phone Number

 

 

 

Name (Last, First, Middle)

Title

Social Security Number

 

 

 

Home Address

Home Phone Number

Cell Phone Number

 

 

 

Name (Last, First, Middle)

Title

Social Security Number

 

 

 

Home Address

Home Phone Number

Cell Phone Number

 

 

 

Name (Last, First, Middle)

Title

Social Security Number

 

 

 

Home Address

Home Phone Number

Cell Phone Number

 

 

 

 

 

 

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 N.J.S.A. §54:39-101 et. seq. (attach rider if necessary).

Individual’s Name

Title with Applicant

Date Joining Applicant

Social Security Number

 

 

 

 

Individual’s Home Address

City, State, Zip

 

 

 

 

 

 

Name of Business with which Affiliation Exists

Affiliated Business FID

Title

Effective Date of Title

 

 

 

 

Address of Business with which Affiliation Exists

City, State, Zip

 

 

 

 

 

 

Individual’s Name

Title with Applicant

Date Joining Applicant

Social Security Number

 

 

 

 

Individual’s Home Address

City, State, Zip

 

 

 

 

 

 

Name of Business with which Affiliation Exists

Affiliated Business FID

Title

Effective Date of Title

 

 

 

 

Address of Business with which Affiliation Exists

City, State, Zip

 

 

Section 7 – Types of Products Handled

Check each type of product you will be dealing with in New Jersey.

Gasoline

 

LPG

 

Dyed Kerosene

 

Undyed Kerosene

Gasohol

 

Undyed Diesel

 

Undyed Biodiesel

 

Aviation Fuel

 

 

 

Fuel Grade Alcohol

 

Dyed Diesel

 

Dyed Biodiesel

 

 

 

 

 

 

Other – List each:

______________________________________________________________________________________________________________

Section 8 – Business Activity; License Requested

Check all that apply.

Supplier of Motor Fuels

An application fee of $450 is due for a 3-year license.

 

 

1. 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. You are a Position Holder in a terminal in New Jersey (List each terminal and provide itslocation).

B. You export fuel from this state (List the states to which you export and provide your License No in each state).

C.You import as a Position Holder in another state (List the states from which you import and provide your License No in each state).

D.You import from another Position Holder (List the Position Holders, the Position Holder’s License No, and provide the state).

E. You acquire motor fuel in this state by two-party exchanges (List exchange partners and provide their License No).

2. You produce Fuel Grade Alcohols in New Jersey or for import into New Jersey.

Permissive Supplier of Motor Fuels

An application fee of $450 is due for a 3-year license.

You are an out-of-state Supplier that is not required to be licensed as a supplier in this state, but you elect to be licensed anyway.

 

 

Terminal Operator

An application fee of $450 is due for a 3-year license, unless

 

 

 

 

already a supplier or applying to become a supplier.

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

You own one or more terminals in New Jersey (List each terminal, state whether it is a barge, pipeline, or fixed location, and provide its location).

 

 

 

 

 

 

 

 

 

 

 

2.

 

You control one or more terminals in New Jersey (List each terminal, state whether it is a barge, pipeline, or fixed location, and provide its location).

 

 

 

 

 

 

 

 

 

 

 

3.

 

You commingle products with those of another company (List each company, and the products commingled).

 

 

 

 

 

 

 

 

 

Distributor of Motor Fuels

An application fee of $450 is due for a 3-year license.

1.You acquire fuel from a Supplier, Permissive Supplier, or another Distributor for subsequent resale within New Jersey.

2.You import fuel from another state (List the states, Suppliers, each Supplier’s License No and the products imported).

3. You export fuel to another state (List the states, customers, each customer’s License No, and the products exported).

4.You blend fuels (List the types of fuels you blend and the blend stocks used).

5.You sell Aviation Fuel.

Retailer of Motor Fuels

An application fee of $150 is due for a 3-year license.

You must file a separate MFA-1 for each retail establishment.

1. You engage in the business of selling or dispensing motor fuel to the consumers in this state.

2. You operate a blocked pump for clear kerosene.

3. You sell Aviation Fuels to theconsumers.

4. You dispense LPG into on-road vehicles.

5. Do you have a backup generator on site?

 

Yes

 

No

6.If yes, please submit a description.

7.If no, is your station pre-wired for a generator?

8. a. Number of gasoline pumps __________

b. Average gallons of gasoline sold during the last 12 months. _______________

 

 

 

9. a. Number of diesel pumps __________

b. Average gallons of diesel fuel sold during the last 12 months. ______________

 

 

10. a. Number of kerosene pumps

 

b. Average gallons of kerosene sold during the last 12 months. _______________

 

11. Do you lease your retail location? (If yes, please provide a copy of the lease agreement)

 

 

Transporter

An application fee of $50 is due for a 1-year license for each

 

 

 

conveyance licensed.

 

 

 

 

 

 

 

 

1.

 

You transport your own fuels.

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

You transport fuels under contract as a common carrier. (List your customers and the fuels transported).

 

 

 

 

 

For each fuel transportation vehicle or vessel, give the following information. (Attach rider if you are licensing more than 20 vehicles or vessels).

Conveyance Type

VIN or Vessel Name

Conveyance Type

VIN or Vessel Name

Total application fee due for this application: $

Section 9 – Consumer Registration

Only consumers may complete this section. If you sell fuel, then you are not a consumer and you must apply for one of the licenses in Section 8.

Check all

 

You purchase dyed fuel for use in on-road vehicles.

 

 

You blend your own fuel.

 

 

 

You pick up taxable, on-road fuel from a terminal.

 

 

You recycle fuel for use on-road.

 

 

that

 

 

 

 

 

apply.

 

You make your own fuel.

 

 

 

 

You acquire taxable fuel that has not been taxed.

 

 

 

 

 

 

 

 

 

 

 

 

Check each type of fuel you will consume.

 

Gasoline or

 

Diesel, Biodiesel

 

 

 

Dyed Diesel, Biodiesel or

 

Aviation Fuel

 

 

 

 

 

 

 

Ethanol

 

or Kerosene

 

 

 

Kerosene

 

 

Section 10 – Fuel Customers / Suppliers / Position Holders

Supplier of Motor Fuels applicants: list your customers. Distributor of Motor Fuels applicants: list your suppliers.

Terminal Operator applicants: list the position holders in your terminal(s). Retailers of Motor Fuels applicants: list your suppliers.

Customer / Supplier / Position Holder

Name

Federal ID No.

License No.

Products

Terminal No.

How product is

received

Section 11 – Transporters Hired

List common carriers you will use to transport fuel.

Transporter Name

Point of Contact

Phone Number

Federal ID Number

Mode

Section 12 – Terminals

Refer to instructions to determine which terminals must be listed (attach rider if necessary).

Terminal Code

Street Address

City, State, Zip

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