Tmt Ny Form – Fill Out and Use This PDF

Department of Taxation and Finance

TMT-1

Application for Highway Use Tax (HUT) and Automotive Fuel

Carrier (AFC) Certiicates of Registration (C of R) and Decals

(4/16)

Order your credentials online in minutes at www.oscar.ny.gov

To use OSCAR all you need is an active USDOT number and a Highway Use Tax (HUT) account

— Read the instructions, Form TMT-1-I, before completing this form.

For ofice use only

— You must complete all lines of this form, except as noted in the instructions. We will return an incomplete application to you.

Total amount

Number of

— All vehicles with HUT or AFC credentials must display decals.

credentials

— This form is available as a ill-in form on our Web site (see Need help? in Form TMT-1-I). Type your information, then print,

sign, and mail it.

$

Deposit number

1

Identiication

Employer identiication number

Sufix, if any

Social security number (SSN)

number

OR

SS

2 USDOT number

3 Telephone number

4 E-mail address

5 Fax number

6 Legal name

7 Doing business as (DBA) name, if different from legal name

8 Physical address ( number and street )

9 Mailing address ( if different than physical address; number and street or PO box )

City

State

ZIP code

City

State

ZIP code

Country ( enter if other than United States; do not abbreviate )

Country ( enter if other than United States; do not abbreviate )

10

Mark an X in the box if your physical or mailing address has changed and has not been reported to us. Enter new address on line 8 and/or line 9, above. If your business

name or tax identiication number has changed and has not yet been reported to us, call us before mailing this application (see Need help? in Form TMT-1-I).

11 Type of business ( mark an X in one box and specify if Other)

Sole proprietor

Corporation

Partnership

LLC

LLP

Other:

12 For new accounts, list the name, title, social security number, and address of each principal oficer of a corporation, or of each partner, or member of an LLC/LLP, or

owner if sole proprietorship.

Name

Title

SSN

Number and street

City

State

ZIP code

13 For new accounts, enter the location where tax and mileage records will be available for audit.

Name of custodian of records

Number and street

City

State

ZIP code

Telephone number

14 If this form is prepared by a company employee who is not an oficer, partner, member, or owner, or by an agent, service, accountant or other

representative, you must provide the information below. Additionally, if you expect to contact the Tax Department about this application or any other tax

matters, you must attach a Power of Attorney (usually Form POA-1) authorizing you to have access to this business’s New York State tax records.

Name of person preparing form

Number and street

City

State

ZIP code

Telephone number

15 Signature of owner, partner, oficer, member or individual with a Power of Attorney on ile with the New York State Tax Department

Certiication: I certify that the above statements are true, complete and correct and that no material information has been omitted. I make these statements with

the knowledge that willfully providing false or fraudulent information with the intent to evade tax may constitute a felony or other crime under New York State Law,

punishable by a substantial ine and possible jail sentence. I also understand that the Tax Department is authorized to investigate the validity of any information

entered on this document.

Signature

Printed name of person signing

Title

Date signed

16 Amount due with application. The C of R and decal (credentials) cost $1.50 per vehicle.

Mail application and payment to:

Number of HUT/AFC credentials ordered

× $1.50 = $

NYS TAX DEPARTMENT

Make check or money order payable in U.S. funds to Commissioner of Taxation and Finance.

HUT/IFTA APPLICATION DEPOSIT UNIT

W A HARRIMAN CAMPUS

ALBANY NY 12227-0863