Tmt 12 Form – Fill Out and Use This PDF

You฀can฀renew฀your฀permits฀on-line฀by฀using฀the฀One฀Stop฀ Credentialing฀and฀Registration฀system฀(OSCAR).฀Visit฀the฀ OSCAR฀Web฀site฀at฀www.oscar.state.ny.us฀or฀call฀1฀800฀518-7352฀ for฀more฀information.฀If฀you฀do฀not฀want฀to฀renew฀online,฀please฀ follow฀the฀instructions฀below.

Read฀these฀instructions฀carefully.฀The฀numbers฀below฀ correspond฀with฀item฀numbers฀on฀the฀front฀and฀back฀of฀ Form฀TMT-1.2.฀You฀must฀complete฀the฀entire฀renewal฀ application,฀or฀it฀will฀be฀returned.

If฀the฀name฀or฀address฀is฀different฀from฀the฀preprinted฀ information฀on฀the฀renewal฀application,฀complete฀Form฀DTF-96,฀ Report฀of฀Address฀Change฀for฀Business฀Tax฀Accounts.฀If฀there฀ has฀been฀a฀change฀of฀entity,฀do฀not฀use฀this฀application;฀use฀ Form฀TMT-1,฀Application฀for฀Highway฀Use฀Tax฀and/or฀Automotive฀ Fuel฀Carrier฀Permits,฀and฀enclose฀a฀permit฀fee฀of฀$15฀for฀each฀ self-propelled฀device,฀and฀$5฀for฀each฀trailer,฀semitrailer,฀or฀other฀ attached฀device฀that฀transports฀automotive฀fuel.

1.฀ If฀not฀preprinted฀on฀the฀form,฀enter฀your฀taxpayer฀ identification฀number฀(FEIN)฀or,฀if฀none,฀your฀social฀ security฀number.

2.฀ If฀not฀preprinted,฀enter฀your฀U.S.฀Department฀of฀ Transportation฀(DOT)฀number.

3.฀ If฀licensed฀under฀the฀International฀Fuel฀Tax฀Agreement฀ (IFTA),฀enter฀your฀base฀jurisdiction฀(state฀or฀province).฀If฀ not฀licensed฀under฀IFTA,฀enter฀none.

4.฀ Enter฀the฀mailing฀address฀for฀permits฀if฀different฀from฀the฀ preprinted฀address.

5.฀ Enter฀the฀business฀telephone฀number.

6.฀ Enter฀the฀address฀of฀the฀office฀where฀records฀are฀ available฀if฀other฀than฀the฀preprinted฀address.฀If฀records฀ are฀maintained฀by฀an฀agent฀or฀representative,฀indicate฀ the฀name฀and฀telephone฀number฀of฀the฀agent฀or฀ representative.

7.฀ Give฀the฀names,฀titles,฀social฀security฀numbers,฀and฀ resident฀addresses฀of฀the฀principal฀corporate฀officers,฀ partners,฀members฀of฀a฀limited฀liability฀company฀or฀ partnership฀(LLC/LLP),฀or฀individual฀owner(s).฀(Include฀ also฀an฀executor,฀administrator,฀receiver,฀trustee,฀or฀other฀ fiduciary.)

8.฀ For฀all฀leased฀vehicles,฀enter฀the฀manufacturer’s฀serial฀ number฀as฀shown฀in฀item฀10฀on฀Form฀TMT-1.2,฀the฀ owner’s฀name,฀federal฀identification฀number฀or฀social฀ security฀number,฀and฀address.

9.฀ This฀application฀must฀be฀signed฀by฀the฀owner,฀partner,฀or฀ corporate฀officer฀assuming฀responsibility฀for฀the฀validity฀ of฀the฀information฀it฀contains.฀

10.฀ Mark฀an฀X฀in฀the฀Do฀not฀renew฀box฀for฀any฀vehicles฀for฀ which฀you฀do฀not฀need฀renewal฀permits฀and฀stickers.฀You฀ may฀use฀this฀form฀to฀increase฀or฀decrease฀unloaded

฀฀and/or฀gross฀weights฀by฀drawing฀a฀line฀through฀the฀ incorrect฀information฀and฀inserting฀the฀revised฀weights฀ above฀the฀weights฀that฀are฀crossed฀out.

฀ The฀unloaded฀weight฀of฀the฀vehicle฀is฀the฀actual฀weight฀ of฀the฀motor฀vehicle฀that฀includes฀all฀equipment฀that฀is฀ necessary฀for฀the฀performance฀of฀the฀function฀of฀the฀ vehicle฀as฀a฀vehicle฀(including฀a฀full฀fuel฀tank),฀necessary฀ for฀the฀safety฀of฀the฀vehicle,฀permanently฀attached฀to฀the฀

vehicle,฀used฀exclusively฀for฀the฀protection฀of฀the฀load฀ carried฀by฀the฀vehicle,฀or฀used฀exclusively฀for฀loading฀or฀ unloading฀of฀the฀vehicle.

฀ The฀gross฀weight฀of฀a฀truck฀is฀the฀unloaded฀weight฀of฀the฀ truck฀plus฀the฀weight฀of฀the฀heaviest฀load฀to฀be฀carried.฀ However,฀if฀a฀truck฀operates฀in฀combination฀with฀a฀trailer฀ or฀other฀attached฀device(s),฀even฀if฀the฀combination฀is฀ used฀only฀on฀an฀occasional฀basis,฀the฀gross฀weight฀of฀the฀ truck-trailer฀combination฀is฀the฀unloaded฀weight฀of฀the฀ truck฀and฀the฀heaviest฀combined฀weight฀of฀the฀trailer฀or฀ other฀attached฀device(s)฀and฀the฀weight฀of฀the฀maximum฀ load฀to฀be฀carried.

฀ The฀gross฀weight฀of฀a฀tractor฀pulling฀one฀or฀more฀trailers฀ or฀other฀devices,฀even฀if฀only฀on฀an฀occasional฀basis,฀ is฀the฀unloaded฀weight฀of฀the฀tractor฀plus฀the฀unloaded฀ weight฀of฀the฀heaviest฀trailer,฀semitrailer,฀dolly,฀or฀other฀ device(s)฀to฀be฀drawn฀by฀the฀tractor,฀plus฀the฀weight฀of฀ the฀heaviest฀load฀(not฀including฀the฀weight฀of฀the฀driver฀or฀ helper)฀to฀be฀carried฀or฀drawn฀by฀the฀tractor.

฀ The฀gross฀weight฀of฀a฀trailer฀transporting฀automotive฀fuel฀ is฀the฀unloaded฀weight฀of฀the฀heaviest฀tractor฀used฀to฀ pull฀the฀trailer,฀semitrailer,฀dolly,฀or฀other฀drawn฀device(s),฀ plus฀the฀unloaded฀weight฀of฀the฀trailer,฀plus฀the฀heaviest฀ load฀to฀be฀carried฀by฀the฀trailer฀being฀drawn.

฀ Note:฀The฀gross฀weight฀of฀a฀tow-truck฀is฀the฀same฀ as฀its฀unloaded฀weight.฀A฀tow-truck฀is฀not฀deemed฀to฀ be฀operating฀in฀combination฀with฀the฀vehicle฀it฀pulls.฀ However,฀a฀tow-truck฀that฀fully฀supports฀a฀vehicle฀on฀its฀ flat฀bed฀would฀have฀to฀include฀the฀weight฀of฀the฀vehicle฀in฀ its฀gross฀weight.

฀Owner฀Equipment฀Number฀(optional)฀—฀if฀you฀assign฀an

฀internal฀tracking฀number,฀such฀as฀a฀unit฀number,฀to฀your฀฀

฀vehicles฀and฀want฀this฀number฀printed฀on฀your฀permit(s),฀฀

฀enter฀it฀in฀the฀Owners฀equipment฀number฀column.

The฀fee฀for฀each฀19th฀series฀renewal฀permit฀and฀sticker฀is฀$4฀for฀ each฀self-propelled฀vehicle฀and฀$2฀for฀each฀trailer,฀semitrailer,฀ or฀other฀attached฀device฀that฀transports฀automotive฀fuel,฀if฀ your฀application฀is฀postmarked฀on฀or฀before฀December฀31,฀

2005.฀Applications฀postmarked฀after฀December฀31,฀2005,฀are฀ subject฀to฀fees฀of฀$15฀and฀$5฀respectively.฀Make฀your฀check฀or฀ money฀order฀for฀the฀total฀amount฀payable฀in฀US฀funds฀to฀the฀ Commissioner฀of฀Taxation฀and฀Finance.฀Do฀not฀send฀cash.฀ Enter฀your฀taxpayer฀identification฀number฀on฀the฀check฀or฀money฀ order.฀Mail฀your฀completed฀application฀to:

฀NYS฀TAX฀DEPARTMENT

฀TSRD฀-฀HUT฀RENEWAL฀UNIT

฀W฀A฀HARRIMAN฀CAMPUS

฀ALBANY฀NY฀12227

Your฀permits฀and฀stickers฀will฀be฀mailed฀to฀you,฀and฀must฀be฀ displayed฀by฀April฀1,฀2006.

If฀you฀need฀a฀new฀permit฀and฀sticker฀for฀a฀vehicle฀not฀currently฀ registered฀use฀Form฀TMT-1,฀Application฀for฀Highway฀Use฀Tax฀ and/or฀Automotive฀Fuel฀Carrier฀Permits.฀Enclose฀with฀Form฀ TMT-1฀a฀permit฀fee฀of฀$15฀for฀each฀self-propelled฀device฀and฀ $5฀for฀each฀trailer,฀semitrailer,฀or฀other฀attached฀device(s)฀that฀ transports฀automotive฀fuel.฀You฀must฀send฀separate฀payments฀ for฀the฀renewal฀permits฀and฀the฀new฀permits.

TMT-1.2-I฀(10/05)฀(back)

Privacy฀Notification

The฀Commissioner฀of฀Taxation฀and฀Finance฀may฀collect฀and฀maintain฀ personal฀information฀pursuant฀to฀the฀New฀York฀State฀Tax฀Law,฀including฀ but฀not฀limited฀to,฀sections฀171,฀171-a,฀287,฀308,฀429,฀475,฀505,฀697,฀ 1096,฀1142,฀and฀1415฀of฀that฀Law;฀and฀may฀require฀disclosure฀of฀social฀ security฀numbers฀pursuant฀to฀42฀USC฀405(c)(2)(C)(i).

This฀information฀will฀be฀used฀to฀determine฀and฀administer฀tax฀liabilities฀ and,฀when฀authorized฀by฀law,฀for฀certain฀tax฀offset฀and฀exchange฀of฀tax฀ information฀programs฀as฀well฀as฀for฀any฀other฀lawful฀purpose.

Information฀concerning฀quarterly฀wages฀paid฀to฀employees฀is฀provided฀ to฀certain฀state฀agencies฀for฀purposes฀of฀fraud฀prevention,฀support฀ enforcement,฀evaluation฀of฀the฀effectiveness฀of฀certain฀employment฀and฀ training฀programs฀and฀other฀purposes฀authorized฀by฀law.

Failure฀to฀provide฀the฀required฀information฀may฀subject฀you฀to฀civil฀or฀ criminal฀penalties,฀or฀both,฀under฀the฀Tax฀Law.

This฀information฀is฀maintained฀by฀the฀Director฀of฀Records฀Management฀ and฀Data฀Entry,฀NYS฀Tax฀Department,฀W฀A฀Harriman฀Campus,฀ Albany฀NY฀12227;฀telephone฀1฀800฀225-5829.฀From฀areas฀outside฀the฀ United฀States฀and฀outside฀Canada,฀call฀(518)฀485-6800.

Need฀help?

฀Internet฀access:฀www.nystax.gov

฀฀ ฀ (for฀information,฀forms,฀and฀publications)

฀

Fax-on-demand฀forms:฀฀

1฀800฀748-3676

฀Telephone฀assistance฀is฀available฀from฀8:00฀A.M.฀to฀5:00฀P.M.

฀฀฀ (eastern฀time),฀Monday฀through฀Friday.

To฀order฀forms฀and฀publications:฀1฀800฀462-8100

Business฀Tax฀Information฀Center:฀1฀800฀972-1233

From฀areas฀outside฀the฀U.S.฀and฀outside฀Canada:฀ ฀(518)฀485-6800

Hearing฀and฀speech฀impaired฀(telecommunications

device฀for฀the฀deaf฀(TDD)฀callers฀only):฀1฀800฀634-2110

฀ Persons฀with฀disabilities:฀In฀compliance฀with฀the฀ Americans฀with฀Disabilities฀Act,฀we฀will฀ensure฀that฀our฀lobbies,฀ offices,฀meeting฀rooms,฀and฀other฀facilities฀are฀accessible฀to฀

persons฀with฀disabilities.฀If฀you฀have฀questions฀about฀special฀ accommodations฀for฀persons฀with฀disabilities,฀please฀call฀1฀800฀972-1233.