Fuel Tax Application Form Indiana Department of Revenue Fuel Tax Section December 2008 American LegalNet, Inc. www.FormsWorkflow.com FT-1 SF# 46297 (R8 / 12-08) Indiana Department of Revenue Fuel Tax License Application This application must be accompanied by a completed Fuel Tax Surety Bond, Irrevocable Standby Letter of Credit (subject to Departmental format) or Cash Bond, and a current financial statement or beginning balance sheet, if applible. (Please print legibly or type the information on this application.) License #_______________ Effective Date ___________ SECTION A: TAXPAYER INFORMATION Contact the Department at (317) 615-2625 for more information regarding this application. 1. Owner name, legal partnership name, corporate name, or other entity name 2. Federal Identification Number (FEIN) 3. Business Trade Name or D/B/A 4. Name of Contact Person (Owner, Partner, or Corporate Officer) 5. Business Location (P.O. Box cannot be used as a business location address) 6. Mailing address City 7. Business Location Telephone Number ( ) State ( ) 10. If your business is currently registered for any Indiana tax under this ownership, enter your Taxpayer Identification Number (TID): 11. Check the type of organization of this business Sole Proprietor Corporation Fed. Govt. LLC LLP Other Govt. County State 9. E-Mail Address City 8. Fax Number ZIP ZIP County Partnership Other 12. All Corporations must answer the following questions: A. State of Incorporation B. Date of Incorporation Month Day NAICS Code: # C. State of Commercial Domicile Year D. If not incorporated in Indiana, enter the date authorized to do business in Indiana. Month Day Year E. Accounting period year ending date Month Day 13. Owner, Partners or Officers (Attach additional sheets if necessary) Social Security Number Last Name, First Name, MI Title Street Address City State ZIP 14. License Type - Place an “X” in the box next to the license type(s) for which you are applying. Terminal Operator Fee Amt $300.00 Supplier Fee Amt $500.00 Permissive Supplier Fee Amt $50.00 Aviation Fuel Dealer Fee Amt $15.00 Importer Fee Amt $200.00 Exporter Fee Amt $200.00 Transporter Fee Amt $50.00 Blender No Fee Required Marina Fuel Dealer Fee Amt $15.00 Petroleum Severance No Fee Required Gasoline Distributor Fee Amt $100.00 Oil Inspection Distributor Fee Amt $100.00 Dyed Fuel User No Fee Required Gasohol Blender No Fee Required 15. Reason License Needed New Business Purchase of Existing Business Purchased from whom ______________________ Other ________________ American LegalNet, Inc. www.FormsWorkflow.com SECTION B: SPECIAL FUEL SUPPLIER ($ 500.00 Registration Fee) When applying for a Special Fuel Supplier’s License, you must also complete Section Q of this application. Your License will not be processed if Section Q is not completed. 1. Indiana Terminal Location(s) Address, City, State, Zip Code Terminal Code Number of Storage Tanks If tanks are leased Name and Address of Lessee Total Terminal Storage Capacity Taxable Special Fuel (#1 Diesel Fuel, #2 Diesel Fuel, Biodiesel and Blended Biodiesel) Nontaxable Special Fuel (Dyed Diesel Fuel, Biodiesel Dyed and Blended Biodiesel Dyed) 2. Annual Estimated Taxable Gallons 3. To calculate bond amount:Total Annual Estimated Taxable Gallons ÷ 6 × $.16 = Bond Amount Required (The bond amount must be in an amount equal to at least 2 months liability, but not less than $2,000.00.) $ .00 SECTION C: SPECIAL FUEL PERMISSIVE SUPPLIER ($ 50.00 Registration Fee) When applying for a Special Fuel Permissive Supplier’s License, you must also complete Section Q of this application. Your License will not be processed if Section Q is not completed. Terminal If tanks are leased Total Terminal 1. Terminal Location(s) Number of Address, City, State, ZIP Code Code Storage Tanks Name and Address of Lessee Storage Capacity Taxable Special Fuel (#1 Diesel Fuel, #2 Diesel Fuel, Biodiesel and Blended Biodiesel) Nontaxable Special Fuel (Dyed Diesel Fuel, Biodiesel Dyed and Blended Biodiesel Dyed) 2. Annual Estimated Taxable Gallons 3. To calculate bond amount: Total Annual Estimated Taxable Gallons ÷ 6 × $.16 = Bond Amount Required (The bond amount must be in an amount equal to at least 2 months liability, but not less than $2,000.00.) $ .00 SECTION D: SPECIAL FUEL TERMINAL OPERATOR ($ 300.00 Registration Fee) 1. Indiana Terminal Location(s) Address, City, State, Zip Code Terminal Code Number of Storage Tanks If tanks are leased Name and Address of Lessee Total Terminal Storage Capacity $ 2. A bond in the amount of $2000.00 is required for a Terminal Operator’s License. 2000.00 SECTION E: SPECIAL FUEL IMPORTER ($ 200.00 Registration Fee) 1. List the states from which you plan to import fuel. A. B. C. Taxable Special Fuel (#1 Diesel Fuel, #2 Diesel Fuel, Biodiesel and Blended Biodiesel) D. Nontaxable Special Fuel (Dyed Diesel Fuel, Biodiesel Dyed and Blended Biodiesel Dyed) 2. Annual Estimated Taxable Gallons 3. To calculate bond amount:Total Annual Estimated Taxable Gallons ÷ 6 × $.16 = Bond Amount Required (The bond amount must be in an amount equal to at least 2 months liability, but not less than $2,000.00.) $ .00 American LegalNet, Inc. www.FormsWorkflow.com 1. List the states to which you plan to export fuel. SECTION F: SPECIAL FUEL EXPORTER ($ 200.00 Registration Fee) A. C. E. B. D. F. 2. You must also submit, with this application, a copy of the license(s) from each of the destination jurisdictions listed above. $ 3. A Bond in the amount of $2,000.00 is required for an Exporter’s License. 2000.00 SECTION G: TRANSPORTER ($ 50.00 Registration Fee) 1. Do you transport fuel in vehicles with a capacity greater than 5,400 gallons? YES / NO If Yes, how many?______________________ 2. Do you transport fuel in vehicles with a capacity of 5,400 gallons or less? YES / NO If Yes, how many?______________________ 3. Do you transport fuel by another manner other than truck? YES / NO If yes, indicate the method of transport: ____ Barge ____ Pipeline 4. A Bond in the amount of $2,000.00 is required for a Transporter’s License. $ 2000.00 SECTION H: SPECIAL FUEL BLENDER (No Fee Required) Blender 1. Do you blend or plan to blend non-taxable fuels with taxable special fuels? YES / NO 2. What fuel types do you blend? 3. List the location(s) where you blend fuel and the storage capacity of the tanks. Location - City, State, ZIP Tank Capacity 4. Estimate the total number of taxable gallons to be blended each calendar year. gallons No bond is required for a Blender’s License. SECTION I: DYED FUEL USER (No Fee Required) Dyed Fuel User 1. Do you use dyed fuel in a motor vehicle? YES / NO 2. List all types of motor vehicles using dyed fuel. 3. List the location(s) where you store dyed fuel and the storage capacity of the tanks. Location - City, State, ZIP 4. Estimate the number of taxable gallons of dyed fuel to be consumed each calendar year. Tank Capacity gallons No bond is required for a Dyed Fuel Users License. American LegalNet, Inc. www.FormsWorkflow.com SECTION K: GASOLINE DISTRIBUTOR ($ 100.00 Fee Required) 1. Are you importing Gasoline? YES / NO From what state(s): 2. Are you exporting Gasoline? YES / NO To what state(s): 3. Do you operate service stations in Indiana? YES / NO Number of service stations: 4. Do you operate bulk storage facilities in Indiana? YES / NO Number of bulk storage facilities operated: 5. If you answered yes to any of the above questions, on an additional sheet of paper, list the complete address, city, state, zip code, type of fuel stored, and storage capacity of each location. 6. Indicate Annual Estimated Taxable Gallonage of the following (indicate Indiana information only): Gasoline/Gasohol/Aviation Gas/Alcohol Jet Fuel/Kerosene A. Total Receipts B. Non-Taxable Disbursement C. Taxable Gallons 7. To calculate bond amount: Annual Estimated Taxable Gallons Line 6 ÷ 4 × $.18 = Bond Amount Required (The bond amount must be in an amount equal to at least 3 months liability, but not less than $2,000.00.) $ .00 SECTION L: OIL INSPECTION DISTRIBUTOR ($ 100.00 Fee Required) 1. Indicate Annual Estimated Taxable Gallonage of the following (indicate Indiana information only) Gasoline/Gasohol/Aviation Gas/Alcohol Jet Fuel/Kerosene Special Fuel A. Total Receipts B. Non-Taxable Disbursement C. Taxable Gallons 2. To calculate bond amount: Annual Estimated Taxable Gallons Line 1 ÷ 4 × $ .01 = Bond Amount Required (The bond amount must be in an amount equal to at least 3 months liability, but not less than $2,000.00.) $ .00 SECTION M: AVIATION FUEL DEALER ($ 15.00 Fee Required) 1. Do you own or operate an airfield? YES / NO If yes, indicate the location: 2. Do you own planes? YES / NO If yes, how many: 3. Do you service other planes? YES / NO 4. What is your gasoline storage capacity? Gallons. 5. Name of your fuel supplier(s): 6. Estimated number of gallons that you will purchase during the first year of your permit: No bond is required for an Aviation Dealer. American LegalNet, Inc. www.FormsWorkflow.com SECTION N: MARINA FUEL DEALER ($ 15.00 Fee Required) 1. Do you own or operate a marina or boat livery? YES / NO If yes, indicate the location:_ __________________________________________________ 2. Do you own motorboats? YES / NO If yes, how many:_ __________________________________________________________ 3. Do you service other boats? YES / NO 4. What is your gasoline storage capacity?________________________________________________ Gallons 5. Name of your fuel supplier(s):________________________________________________________________________________________________________ 6. Estimated number of gallons that you will purchase during the first year of your permit:_ _________________________________________________________ No bond is required for a Marina Dealer. SECTION O: PETROLEUM SEVERANCE (No Fee Required) 1. Estimated Annual Barrels:_______________________________ No bond is required for a Petroleum Severance Permit. SECTION P: GASOHOL BLENDER (No Fee Required) 1. Estimated Annual Gallons:_______________________________ 2. What fuel types do you blend? _____________ _____________ _____________ _____________ _____________ No bond is required for a Gasohol Blender Permit. SECTION Q: TAX PRECOLLECTION AGREEMENT (Must be completed by Suppliers and Permissive Supplier) 1. Check one of the following: _______ I choose Option 1 and agree to treat all out-of-state terminal removals of undyed special fuel for export into Indiana as if they were received in Indiana, and will collect the Indiana Special Fuel Tax from every purchaser. _______ I choose Option 2 and enter into a tax precollection agreement with the following importer(s). I have notified customers according to department guidelines. If choosing Option 2, complete the Importer information for each company from which you have elected to collect the Indiana tax. Attach additional sheets if necessary. _______ I choose Option 3 and will not be be collecting tax on any imports. I have notified customers according to department guidelines. _________________________________________________ Supplier / Permissive Supplier Signature ____________________________ Title ______________ Date ___________________________ Daytime Phone Number 2. Importer Information: Name License Number Address Federal Identification Number City ZIP State As an importer of undyed special fuel into Indiana, I agree to be a party to this tax precollection agreement and to pay all tax due to the supplier in accordance with Indiana law. _________________________________________________ ___________________________ ______________ ___________________________ Importer Signature Title Date Daytime Phone Number American LegalNet, Inc. www.FormsWorkflow.com SECTION R: WAIVER (Optional) This is a waiver of the right of confidentiality of this company’s Gasoline Tax and Special Fuel Tax reports to which it is entitled under Indiana code 6-8.1-7-1. This waiver authorizes the Department of Revenue to give information from those tax returns to a customer or supplier of this company and amounts reported by those customers or suppliers. This waiver permits the Indiana Department of Revenue to disclose information from tax returns filed by this company to a customer or supplier who files reports with the Indiana Department of Revenue, or in cases when the customer or supplier has not reported a transaction reported by this company. This waiver may be cancelled by an authorized representative of this company advising the Administrator of the Returns Processing Division of the Indiana Department of Revenue in writing of the cancellation of this waiver. Taxpayer or Authorized Agent’s Signature Name of License Holder (same as indicated on license) Typed or Printed Name Date ( Title ) (Area Code) Business Phone Number SECTION S: SIGNATURE (This section must be completed by all applicants) I do hereby certify under penalty of perjury that the foregoing and attached information is a true and correct statement to the best of my knowledge and is a complete and full representation based upon the best information available. ( Signature Title Date ) Phone Number This application must be signed by the owner, general partner, or corporate officer before it will be processed by the Department. For more information regarding this application, you may contact the Department at (317) 615-2625. Mail completed application, all relevant documentation, and application fees to: Indiana Department of Revenue Fuel Tax, Bonds and Licensing Section P.O. Box 6114 Indianapolis, IN 46206-6114 American LegalNet, Inc. www.FormsWorkflow.com Indiana Department of Revenue Instructions for completing Fuel Tax License Application Form FT-1 Section A: Taxpayer Information General Information Form FT-1 is the license application to be used when registering with the Indiana Department of Revenue, Fuel Tax Section, for Special Fuel and Gasoline licensing requirements, or a combination of both. This form also allows you to add a new license type to an existing registered location in the event your business activities expand. This application is separated by license type. The following table indicates which sections you must complete depending upon the type of licenses you wish to obtain: License Types: All applicants must complete this section. The information requested is general taxpayer information. All requested information must be supplied. 1. Owner Name, Legal Partnership Name, Corporate Name, or Other Entity Name. If you are a sole proprietor, enter your last name, first name, and middle initial. If you are a corporation, enter your corporate name as listed on your corporate charter. If you are a partnership and have a legal partnership name, enter the name as recognized by the Internal Revenue Service. All government agencies should list their proper agency name. 2. Federal Employer Identification Number. Enter your Federal Employer Identification Number. According to Federal guidelines, most partnerships and all corporations are required to obtain a Federal Employer Identification Number. This number is also required whenever you withhold Federal income tax from employees, regardless of ownership type. If you have applied for a Federal Employer Identification number but have not yet received one, indicate “applied for” on this line. You may get this number by completing the Internal Revenue Service Form, SS-4. The Internal Revenue Service assigns your Federal Employer Identification Number to you. 3. Business Trade Name. If you operate your business using a trade or d/b/a name, enter that name. 4. Contact Person. Enter the name of a person within your organization whom the Indiana Department of Revenue may contact about fuel tax related matters. 5. Business Location. Indicate the actual location of your business by providing the street address, city, state, zip code, and county. Note: A post office box is not acceptable as a business location address. Complete Sections: Special Fuel Supplier A, B, D, E, F, G, H, Q, R, S Special Fuel Permissive Supplier A, C, D, Q, R, S, E Special Fuel Terminal Operator A, D, R, S Special Fuel Importer A, E, R, S Special Fuel Exporter A, F, R, S Special Fuel Transporter A, G, R, S Special Fuel Blender A, H, R, S Dyed Fuel User A, I, R, S Gasoline Distributor A, K, R, S Oil Inspection A, L, R, S Aviation Fuel Dealer A, M, R, S Marina Fuel Dealer A, N, R, S Petroleum Severance A, O, R, S Gasohol Blender A, P, R, S Note: Section R, waiver, is optional. Important: ♦ All applicable questions must be answered. Failure to do so will result in a delay in processing and/or issuing your license(s). ♦ Please print legibly or type the information on your application. ♦ Any outstanding tax liabilities owed by the applicant or an owner, partner, or officer will delay application approval. ♦ To complete the license application, follow the section by section instructions. 6. Mailing Address. Indicate the mailing address for your business. Include the street address, post office box, city, state and ZIP code. 7. Business Telephone Number. Enter the telephone number of your business including the area code. If applicable, include an extension. American LegalNet, Inc. www.FormsWorkflow.com 8. Fax Number. Enter the fax number of your business including the area code. 9. E-mail Address. Enter the E-mail address of someone in your business that would receive e-mail correspondence concering fuel tax matters with the Department. 10. Indiana Taxpayer Identification Number. The Taxpayer Identification Number (TID) is applicable only if you have previously registered with the Department. The TID is a 10-digit number as shown on the Registered Retail Merchant Certificate. If you have previously registered, enter your TID on this line. 11. Ownership Type. This line is used to indicate the type of ownership of your organization. You operate a Sole Proprietorship if you own the business as an individual. You operate a Partnership if you have a business partner(s) owning a portion of the business. You operate a Corporation if you filed with the Indiana Secretary of State or requested that office to authorize your business activities in Indiana. You are an LLP or LLC if you have been given such status from the federal government and have registered through the Indiana Secretary of State’s Office. You are classified as Federal Government (Federal Government) if you are a federal agency, or federally chartered organization (e.g. American Red Cross), national bank, or federal credit union. You have a Government (Other Government) classification if you are a political subdivision of the State of Indiana. Such agencies include state, county or city government, town boards, township trustees, and certain volunteer fire departments when under the control of the township trustee. Other entities are all other ownership types. Indicate what “other” organization you are registering for. NAICS Code. Included in this packet is a North American Industrial Classification System list categorizing business types. Examine the codes and list the one that best suits your business activities. 12. Corporation Information. This information is to be completed only if you are a foreign or domestic corporation. A. State of Incorporation is the state where your Articles of Incorporation are filed. B. Date of Incorporation is the date you incorporated. C. State of Commercial Domicile is the principal place from where your trade or business is direct- ed or managed. Commercial domicile is not necessarily in the state of incorporation. D. Enter the date you were authorized to do business in Indiana. Authorization to do business in Indiana must be obtained from the Indiana Secretary of State’s Office. The telephone number is (317) 232-6531. www.in.gov/sos E. Accounting Period Year Ending Date is the month and day your corporation closes its books. If you are on a calendar year, your accounting period date is December 31st (12/31). If you you are on a fiscal year, the accounting period date will be any date other than Dec. 31st. 13. Name of Owner and/or Officers. List the following information regarding the owners, partners, or officers of your business. If the business is a Sole Proprietorship, enter your social security number, last name, first name, middle initial, title as owner, and home address. If the business is a Partnership, enter each general partner’s social security number, name, title of the partner, and home address. If the business is a Corporation, enter the social security numbers, names of the corporate officers, titles, and home addresses. If the business is a Government Agency or other type of ownership, enter social security number(s), name(s) of official officer(s), title(s), and home address(es). Social security numbers are required in accordance with IC 4-1-8-1. Affiliates of the registering entity listed on Line 3 must provide the federal identification number, its entity name and address as well as the names, addresses, and social security numbers of the affiliate’s responsible officers or partners. Attach additional sheets if necessary. 14. License Type. Indicate which license type(s) you are applying for by placing an “X” in the applicable box(es). You may apply for more than one (1) license type per application. 15. Reason License Needed. All applicants must complete this section. Indicate if this is a new business or the purchase of an existing business. Include the name of the person from whom you purchased the business. If the reason is other, indicate reason. Any time a company changes ownership or obtains a new Federal Employer Identification number, a new license is required. American LegalNet, Inc. www.FormsWorkflow.com Section B: Special Fuel Supplier’s License Section C: Special Fuel Permissive Supplier’s License This section must be completed if you wish to apply for a This section must be completed if you wish to apply for a Permissive Supplier’s license. A Permissive Supplier is any person who does not meet the geographical jurisdictional connections to Indiana required of a Supplier, but who holds an inventory position in a federally qualified terminal located outside of Indiana and who is registered under Section 4101 of the Internal Revenue Code. Supplier’s License. A Supplier is a person who 1) imports or acquires immediately upon import into Indiana special fuel via pipeline or marine vessel from another state into a terminal in Indiana; 2) imports special fuel into Indiana from a foreign country; 3) produces, manufactures, or refines special fuel in Indiana; or 4) owns special fuel in the pipeline and terminal distribution system in Indiana and is subject to the general taxing or police jurisdiction of Indiana, and in any case is also registered under Section 4101 of the Internal Revenue Code. Note: Licensed Suppliers are required to remit taxes due to the Department by Electronic Funds Transfer (EFT). The EFT paperwork will be forwarded to you upon receipt of your completed application or you can contact the department to request that it be sent to you by calling (317) 232-5500. 1. 2. 3. Indiana Terminal Locations. Indicate the physical location of the terminal(s). Include your terminal code and the number of storage tanks at the terminal location. If any storage tanks are leased, indicate the name and address of the lessee. Indicate the total storage capacity within the terminal. Note: A post office box number is not acceptable as a terminal address. Annual Estimated Taxable Gallons. Indicate your annual estimated taxable gallons for “Taxable Special Fuel (#1 Diesel Fuel, #2 Diesel Fuel, Biodiesel and Blended Biodiesel)” and “Nontaxable Special Fuel (Dyed Diesel Fuel, Biodiesel Dyed and Blended Biodiesel Dyed)”. A minimum bond of $2,000 is required. Bond. Estimate the annual (12 months) taxable gallons. Divide the amount by six to determine your two months average taxable gallons. Multiply the two months average taxable gallons by the current tax rate of $.16 per gallon to determine the bond amount required. A minimum bond of $2,000 is required. Note: A licensed Supplier does not have to apply for any other license type. Once you obtain a Supplier’s license, you are automatically qualified to operate as a Terminal Operator Oil Inspection Distributer, Transporter, Importer, Exporter, or Blender. If you want to obtain any of the previously mentioned licenses, you must complete the required section for each license. Suppliers who operate terminals will be required to file the terminal operator’s monthly report, Form SF-501. Note: Licensed permissive suppliers are required to remit taxes due to the department by Electronic Funds Transfer (EFT). The EFT paper work will be forwarded to you upon receipt of your completed application or you can contact the department to request that it be sent to you by calling (317) 232-5500. 1. Terminal Locations. Indicate the physical location of each terminal. Include the terminal codes and the number of storage tanks at each terminal location. If any storage tanks are leased, indicate the name and address of the lessee. Indicate the total storage capacity within the terminal. Note: A post office box number is not acceptable as a terminal address. 2. Annual Estimated Taxable Gallons. Indicate your annual estimated taxable gallons for “Taxable Special Fuel (#1 Diesel Fuel, #2 Diesel Fuel, Biodiesel and Blended Biodiesel)” and “Nontaxable Special Fuel (Dyed Diesel Fuel, Biodiesel Dyed and Blended Biodiesel Dyed)”. 3. Bond. Estimate the (12 months) annual taxable gallons. Divide the amount by six to determine your two months average taxable gallons. Multiply your two months taxable gallons by the current tax rate of $ .16 per gallon, to determine the bond amount required. A minimum bond of $2,000 is required. Note: A Permissive Supplier must apply for a Transporter’s, Exporter’s or Blender’s License if they wish to transport, export, or blend special fuel. Note: A current financial statement, beginning balance sheet, or year-end report must accompany this application. Note: A current financial statement, beginning balance sheet, or year end statement must accompany this application. American LegalNet, Inc. www.FormsWorkflow.com Section D: Special Fuel Terminal Operator’s License This section must be completed if you wish to apply for a Terminal Operator’s license. A Terminal Operator is a person (other than a supplier) who, by ownership or contractual agreement, is charged with the responsibility and physical control over the operation of the terminal. 1. Terminal Location. Indicate the physical location of the terminal(s). Include your terminal code and the number of storage tanks at each terminal location. If any of the tanks are leased, you must list the name and address of each lessee. Indicate the total storage capacity within each terminal. Note: A post office box number is not acceptable as a terminal address. 2. Bond. A bond in the amount of $ 2,000.00 is required for a Terminal Operator’s License. Note: A current financial statement, beginning balance sheet, or year-end statement must accompany this application. determine the required bond amount. A minimum bond of $2,000 is required. Note: A current financial statement, beginning balance sheet or year-end report must accompany this application. Section F: Special Fuel Exporter’s License This section must be completed if you wish to apply for an Exporter’s License. An exporter is any person (other than a supplier) who purchases special fuel in Indiana for the purpose of transporting or delivering the fuel to another state or country. Each person engaged in business in Indiana as an Exporter must be licensed in the destination jurisdiction either to collect and remit special fuel taxes in that jurisdiction or to deal in tax free special fuel in that jurisdiction. 1. Export States. List the states to which you plan to export special fuel. 2. Destination State Licenses. You must also submit with this application, a copy of the license(s) authorization card from the destination jurisdictions to which you are exporting special fuel. An Exporter’s license will not be issued without this information. Section E: Special Fuel Importer’s License This section must be completed if you wish to apply for 3. Bond. A bond in the amount of $2,000.00 is required for an Importer License. An importer is a person (other than a supplier or permissive supplier) who wishes to cause undyed special fuel to be delivered into Indiana on the person’s own behalf, for the person’s own account or for resale to an Indiana purchaser. If the special fuel is for resale to an Indiana purchaser, then the fuel must be transported from another state by truck, pipeline, or barge into storage facilities other than qualified terminals. 1. List the states from which you plan to import into Indiana. 2. Annual Estimated Taxable Gallons. Indicate your annual (12 months) estimated taxable gallons for the “Taxable Special Fuel (#1 Diesel Fuel, #2 Diesel Fuel, Biodiesel and Blended Biodiesel)” and “Nontaxable Special Fuel (Dyed Diesel Fuel, Biodiesel Dyed and Blended Biodiesel Dyed).” 3. Bond. Estimate the annual (12 months) taxable gallons from sales to Indiana customers. Divide the amount by six to determine your two months average taxable gallons. Multiply your two months average taxable gallons by the current tax rate of $ .16 per gallon to this license. Note: A current financial statement, beginning balance sheet, or year-end report must accompany this application. Section G: Special Fuel Transporter’s License This section must be completed if you wish to apply for a Transporter’s License. A Transporter is defined as any person, (other than a supplier) who wishes to transport special fuel by whatever manner (i.e. truck, barge, rail, pipeline) from a point outside Indiana to a point inside Indiana, or from a point inside Indiana to a point outside Indiana. Regardless of whether the person is engaged for hire in interstate commerce or for hire in intrastate commerce, they must obtain a Transporter’s license prior to doing so. 1-3. Complete questions 1 through 3 4. Bond. A bond of $2,000.00 is required for a Transporter’s license. American LegalNet, Inc. www.FormsWorkflow.com Note: A current financial statement, beginning balance sheet, or year-end report must accompany this application. Note: Answer all questions completely. This information will be used to determine if you meet the requirements. Section H: Special Fuel Blenders Section K: Gasoline Distributor’s License This section must be completed if you wish to apply for authorization from the Department to become a Special Fuel Blender. A Blender is a person who engages in the process of blending excluding biodiesel and blended biodiesel. Blending is the mixing of one or more petroleum products, with or without product if the product obtained by the blending is capable of use in the generation of power for propulsion of a motor vehicle, an airplane, or a motorboat. Note: Answer all questions completely. This information will be used to determine if you meet the requirements. 1. Are you blending or do you plan to blend non-taxable fuel with taxable fuels? Circle Yes or No on the application. 2. If you circled Yes, enter the types of fuel you plan to blend. A Gasoline Distributor is a person who: ♦ First receives gasoline in Indiana and subsequently distributes such gasoline to other commercial accounts by tank car, tank truck, or transport; and/or ♦ Purchases, or otherwise transferred, gasoline which is imported into Indiana by a person not licensed as a gasoline distributor, via tank car, tank truck, or transport or first receives gasoline which is withdrawn from a pipeline, terminal, barge or refinery. “Gasoline” is defined as all products commonly or commercially known or sold as gasoline, including casing head and absorption or natural gasoline, regardless of their classifications or uses. Therefore, “gasoline” is regular gasoline, unleaded gasoline, gasohol (regardless of the percentage of alcohol additives), natural gasoline, aviation gasoline, and racing gasoline. Complete questions 1 through 5 on the application to indicate the type of business activities operated in Indiana to be covered by this license. 3. List the location(s) and tank capacity where you blend fuel. 4. Estimate the total number of annual (12 months) taxable gallons to be blended each year. On questions 1 through 5, if you answered Yes to any question, indicate the location, storage capacity, and type of fuel stored for each location. Section I: Dyed Fuel Users 6. Complete lines A through C to indicate the annual estimated gallonage of each type of fuel listed. Indicate Indiana gallons only. Total each column. A Dyed Fuel User is a person who qualifies for the federal diesel fuel tax exemption under Section 4082 of the Internal Revenue Code to operate motor vehicles on highways with dyed fuel in the fuel supply tank. No fee or bond is required. 1. Do you use dyed fuel in a motor vehicle? Circle Yes or No on the application. 2. If you circled Yes, list all types of motor vehicles using dyed fuel. 3. List the locations where you store dyed fuel and the storage capacity of the tanks. 4. Estimate the annual number (12 months) of taxable gallons of dyed fuel consumed each year. 7. Bond. Estimate the annual (12 months) total taxable gallons. Divide this amount by four to determine your three months taxable gallons. Multiply the three months’ total by $0.18 to determine the bond amount required. If your monthly tax liability will exceed $5,000.00 you will be required to file by EFT. Note: A current financial statement, beginning balance sheet, or year-end report must be filed with this application. Section L: Oil Inspection Distributor This section must be completed if you wish to apply for an Oil Inspection Distributor license. Oil inspection fees are imposed on gasoline and special fuel products. You must apply for an oil inspection distributor license if you distribute any of the above-mentioned products. If you hold an Indiana American LegalNet, Inc. www.FormsWorkflow.com Gasoline Distributor’s license or Special Fuel license, you are automatically registered as an oil inspection distributor. ♦ Agrees to purchase gasoline from such distributor free of 1. Complete lines A through C to indicate the annual estimated gallonage of each type of fuel listed. Indicate Indiana gallons only. Total each column. 2. Bond. Estimate the annual (12 months) taxable gallons. Divide this amount by four to determine three months taxable gallons. Multiply the three month’s totals by $.01 to determine the bond amount required. from any person who is not a Licensed Gasoline Distributor; and ♦ Agrees not to sell gasoline purchased under the permit authority for use other than to propel a motor boat engine. Complete questions 1 through 6. the gasoline tax, under the authority of the certificate; ♦ Agrees to pay the gasoline tax if the gasoline is purchased Section O: Petroleum Severance Note: A current financial statement, beginning balance sheet, or year-end report must be filed with this application. Section M: Aviation Fuel Dealer Any person located at an airport in Indiana who sells gasoline at such airport for the exclusive purpose of propelling aircraft engines and who delivers the gasoline directly into the fuel supply tank of the aircraft, may apply for an Aviation Fuel Dealer Permit. The permit holder: This section is to be completed by all purchasers of petroleum products or gatherers of petroleum products who transport such products from the place of production. The purchaser or gatherer is imposed with the responsibility to make reports of the severence of petroleum products from the land and the payment of the tax thereupon for and on behalf of the owner or producer of the products as their interests may be. 1. Total of barrels or units purchased or gathered from the ground. Section P: Gasohol Blender ♦ Agrees to properly complete an exemption certificate and present it to a Licensed Gasoline Distributor; ♦ Agrees to purchase gasoline from such distributor, free of the gasoline tax, under the authority of the certificate; ♦ Agrees to pay the gasoline tax if the gasoline is purchased from any person who is not a Licensed Gasoline Distributor; and ♦ Agrees not to sell gasoline purchased under the permit authority for use other than to propel an aircraft engine. A Gasohol Blender’s Permit is required to blend alcohol or other non-taxable products with tax paid gasoline. 1. Section Q: Tax Precollection Agreement Complete questions 1 through 6. Section N: Marina Fuel Dealer Any person operating a marina facility (i.e. marina or boat livery), on Lake Michigan or the Ohio River, who sells gasoline at that facility for the exclusive purpose of propelling motorboat engines, and delivers the gasoline directly into the fuel supply tanks of motorboats, may apply for a Marina Fuel Dealer’s Permit. The permit holder: Indicate the estimated total number of gallons of nontaxable product to be blended with gasoline. All Suppliers and Permissive Suppliers who are selling special fuel for import into Indiana must complete this section. You must select Option 1, Option 2 or Option 3. 1. Check one of the options.You may only select one option. If Option 2 is selected, complete the importer information for each importer from whom you are going to collect tax. Attach additional sheets if necessary. 2. Importer information: This table is to be completed for each importer from whom you have elected to collect the tax. ♦ Agrees to properly complete an exemption certificate and present it to a Licensed Gasoline Distributor; American LegalNet, Inc. www.FormsWorkflow.com Section R: Waiver (Optional) This section should be completed if you wish to give the Department permission to share tax return information with your fuel provider/customer to resolve reporting discrepancies. This waiver may apply to all license types held by the taxpayer. The waiver is an optional form. You are not required to complete this section. If you do not sign the waiver, you may be contacted and requested to send additional information concerning your return in the event of reporting discrepancies. Mail the completed application, surety bond, letter of credit, or cash bond form, current financial statement and the applicable license fee(s) to: Indiana Department of Revenue Fuel Tax Bonds & Licensing Section P.O. Box 6114 Indianapolis, IN 46206-6114 For additional information or assistance in completing this application, please contact the department at the above address, email us at fetax@dor.in.gov, or call us at (317) 615-2625. Section S: Signature The application must be signed and dated by the owner, general partner, or a corporate officer listed in Section A of this application. You must also include the person’s title and a phone number at which this person may be reached. Your application will not be processed without a signature. Additional Information Some of the license types for which this application is being filed require a surety bond, cash bond, or letter of credit. To determine the required bond amount, check the license type(s) for which you are applying. This figure must be rounded to the nearest thousand-dollar amount. If submitting a letter of credit, contact the Department for specific guidelines which must be followed. If submitting a cash bond, contact the department for the proper form. All special fuel types may be included on one bond form. The bond should indicate each license type and the amounts being covered. A separate bond is required for the gasoline license types. Note: All bonds must be completed, signed, and notarized with a Power of Attorney attached before any license(s) can be issued. Stop!! Before you submit your license and bonding information, have you: ♦ Completed all required sections of the license ♦ ♦ ♦ ♦ application? Enclosed a check payable to the Indiana Department of Revenue, if applicable? Signed and dated the application? Enclosed an executed surety bond, letter of credit, or cash bond equal to the amount required for each license type, if applicable? Enclosed a current financial statement, beginning balance sheet, or year end report? American LegalNet, Inc. www.FormsWorkflow.com Indiana Department of Revenue North American Industry Classification System (NAICS) (Revised 07/03) This list of principal business activities and their associated codes is designed to classify an enterprise by type of activity in which it is engaged. These six-digit codes are derived from the North American Industry Classification System (NAICS) and do not resemble prior year codes. Select the category that best describes your primary business activity (for example Real Estate). Then select the activity that best identifies the principal source of your sales or receipts (for example, real estate agent). Now find the six-digit code assigned to this activity and enter it on all appropriate forms. The business tax application (BT-1) will accommodate up to four (4) different codes related to your business. The codes will assist the Department in mailing tax bulletins and other information applicable to your business. For additional NAICS activity codes, you may view our web site at: https://www.ai.org/apps/dor/bt1/naics.html Code Code Accommodation, Food Services, and Drinking Places (720000) 112000 112111 112112 112120 112210 112300 112400 112510 112900 113000 113110 113210 113310 114000 114110 114210 115000 115110 115210 115310 721000 721110 721120 721191 721199 721210 721310 722000 722100 722210 722300 722320 722410 Accommodation Hotels (except casino hotels) and Motels Casino Hotels Bed-and-Breakfast Inns All Other Traveler Accommodation RV (Recreational Vehicle) Parks & Recreational Camps Rooming and Boarding Houses Food Services & Drinking Places Full-Service Restaurants Limited-Service Eating Places Special Food Services (including food service contractors & caterers) Caterers Drinking Places (Alcoholic Beverages) Administrative and Support & Waste Management and Remediation Services 561000 561110 561210 561300 561410 561420 561430 561440 561450 561490 561499 561500 561520 561600 561700 561710 561720 561730 561740 561790 561900 562000 Administrative & Support Services Office of Administrative Services Facilities Support Services Employment Services Document Preparation Services Telephone Call Centers Business Service Centers (including private mail centers & copy shops) Collection Agencies Credit Bureaus Other Business Support Services (including repossession services, court reporting, & stenotype services) All Other Business Support Services Travel Arrangement & Reservation Services Tour Operators Investigation and Security Services Services to Buildings and Dwellings Exterminating & Pest Control Services Janitorial Services Landscaping Services Carpet & Upholstery Cleaning Services Other Services to Building & Dwellings Other Support Services (including pack- aging & labeling services, and convention & trade show organizers) Waste Management and Remediation Services Agriculture, Forestry, Hunting & Fishing 110000 111000 111100 111210 111300 111400 111900 Agriculture, Forestry, Fishing and Hunting Crop Production Oilseed & Grain Farming Vegetable & Melon Farming (including potatoes & yams) Fruit & Tree Nut Farming Greenhouse, Nursery, & Floriculture Production Other Crop Farming (including tobacco, cotton, sugar cane, hay, peanut, sugar beet & all other crop farming) Code Animal Production Beef Cattle Ranching & Farming Cattle Feedlots Dairy Cattle & Milk Production Hog and Pig Farming Poultry & Egg Production Sheep & Goat Farming Animal Aquaculture (including shellfish & finfish farms and hatcheries) Other Animal Production Forestry and Logging Timber Tract Operations Forest Nurseries & Gathering of Forest Products Logging Fishing, Hunting and Trapping Fishing Hunting and Trapping Support Activities for Agriculture and Forestry Support Activities for Crop Production (including cotton ginning, soil preparation,planting & cultivating) Support Activities for Animal Production Support Activities for Forestry Arts, Entertainment, and Recreation (710000) 711000 711100 711110 711120 711130 711190 711210 711300 711410 711510 712100 713000 713100 713110 713200 713900 Performing Arts, Spectator Sports, and Related Industries Performing Arts Companies Theater Companies & Dinner Theaters Dance Companies Musical Groups & Artists Other Performing Arts Companies Spectator Sports (including sports clubs & racetracks) Promoters of Performing Arts, Sports, & Similar Events Agents and Managers for Artists, Athletes, Entertainers, and Other Public Figures Independent Artists, Writers, & Performers Museums, Historical Sites, & Similar Institutions Amusement, Gambling, and Recreation Industries Amusement Parks & Arcades Amusement & Theme Parks Gambling Industries Other Amusement & Recreation Industries (including golf courses, skiing, facilities, marinas, fitness centers, & bowling centers) Construction (230000) 233000 233110 233200 233300 234000 234100 Building, Developing, & General Constructing Land Subdivision & Land Developing Residential Building Construction Nonresidential Building Construction Heavy Construction Highway, Street, Bridge, & Tunnel Construction 234900 235000 235110 235500 235210 235310 235400 235610 235710 235810 235900 Other Heavy Construction Special Trade Contractors Plumbing, Heating, & Air-Conditioning Contractors Carpentry & Floor Contractors Painting & Wall Covering Contractors Electrical Contractors Masonry, Drywall, Insulation, & Tile Contractors Roofing, Siding, & Sheet Metal Contractors Concrete Contractors Water Well Drilling Contractors Other Special Trade Contractors Educational Services 611000 611110 611310 611510 611600 Educational Services Elementary & Secondary Schools Colleges, Universities and Professional Schools Technical and Trade Schools Other Schools and Instruction Finance and Insurance (520000) 522100 522110 522120 522130 522190 522200 522210 522220 522290 522291 522292 522293 522294 522298 522300 523100 523110 523120 523130 523140 523210 523900 524000 524113 524114 524121 524126 524130 524140 524150 Depository Credit Intermediation Commercial Banking Savings Institutions Credit Unions Other Depository Credit Intermediation Nondepository Credit Intermediation Credit Card Issuing Sales Financing Other Non-depository Credit Intermediation Consumer Lending Real Estate Credit (including mortgage bankers and originators) International Trade Financing Secondary Market Financing All Other Nondepository Credit Intermediation Activities Related to Credit Intermediation (including loan brokers) Securities, Commodity Contracts, and Other Intermediation and Brokerage Investment Banking & Securities Dealing Securities Brokerage Commodity Contracts Dealing Commodity Contracts Brokerage Securities and Commodity Exchanges Other Financial Investment Activities (including portfolio management & investment advice) Insurance Carriers and Related Activities Direct Life Insurance Carriers Direct Health & Medical Insurance Carriers Property & Casualty Insurance Carriers Direct Property and Casualty Insurance Carriers Reinsurance Carriers Direct Life, Health, and Medical Insurance & Reinsurance Carriers Direct Insurance & Reinsurance (except Life, Health & Medical) Carriers American LegalNet, Inc. www.FormsWorkflow.com North American Industry Classification System (continued) Code 524210 524290 524292 524298 525000 525100 525910 525920 525930 525990 Insurance Agencies and Brokerages Other Insurance Related Activities Third Party Administration for Insurance and Pension Funds All Other Insurance Related Activities Funds, Trusts, and Other Financial Vehicles Insurance & Employee Benefit Funds Open-End Investment Funds (Form 1120-RIC) Trusts, Estates, and Agency Accounts Real Estate Investment Trusts (Form 1120-REIT) Other Financial Vehicles Health Care and Social Assistance (620000) 621000 621110 621111 621112 621210 621300 621310 621320 621330 621340 621391 621399 621400 621410 621420 621491 621492 621493 621498 621510 621610 621900 621910 621990 621991 622000 623000 623990 624000 624100 624200 624310 624410 Ambulatory Health Care Services Offices of Physicians Offices of Physicians (except mental health specialists) Offices of Physicians, Mental Health Specialists Offices of Dentists Offices of Other Health Practitioners Offices of Chiropractors Offices of Optometrists Offices of Mental Health Practitioners (except Physicians) Offices of Physical, Occupational & Speech Therapists, and Audiologists Offices of Podiatrists Offices of All Other Miscellaneous Health Practitioners Outpatient Care Centers Family Planning Centers Outpatient Mental Health & Substance Abuse Centers HMO Medical Centers Kidney Dialysis Centers Freestanding Ambulatory Surgical and Emergency Centers All Other Outpatient Care Centers Medical and Diagnostic Laboratories Home Health Care Services Other Ambulatory Health Care Services Ambulance Services All Other Ambulatory Health Care Services Blood and Organ Banks Hospitals Nursing & Residential Care Facilities Other Residential Care Facilities Social Assistance Individual & Family Services Community Food & Housing, and Emer- gency & Other Relief Services Vocational Rehabilitation Services Child Day Care Services Information (510000) 511100 511110 511120 511130 511140 511190 511210 512000 512100 512200 513000 513100 513200 Publishing Industries Newspaper Publishers Periodical Publishers Book Publishers Database and Directory Publishers Other Publishers Software Publishers Motion Picture & Sound Recording Industries Motion Picture & Video Industries (except video rental) Sound Recording Industries Broadcasting and Telecommunications Radio & Television Broadcasting Cable Networks & Program Distribution Code 513300 514000 514100 514210 Telecommunications (including paging, cellular, satellite, & other telecommuni- cations) Information Services & Data Processing Services Information Services (including news syndicates, libraries, & on-line Information services) Data Processing Services Manufacturing 311000 311110 311200 311300 311500 311610 311710 311800 311900 312000 312110 312120 312130 312140 312200 313000 314000 315000 315100 315210 315220 315230 315290 315990 316000 316110 316210 316990 321000 321110 321210 321900 322000 322100 322200 323100 323117 323119 324000 324110 324120 324190 325000 325100 325200 325300 325410 325500 325600 325900 326000 326100 326200 327000 327100 Food Manufacturing Animal Food Manufacturing Grain & Oilseed Milling Sugar & Confectionery Product Mfg. 311400 Fruit & Vegetable Preserving & Specialty Food Manufacturing Dairy Product Manufacturing Animal Slaughtering & Processing Seafood Product Preparation & Packaging Bakeries & Tortilla Manufacturing Other Food Manufacturing (including coffee, tea, flavorings & seasonings) Beverage and Tobacco Product Mfg. Soft Drink and Ice Manufacturing Breweries Wineries Distilleries Tobacco Manufacturing Textile Mills Textile Product Mills Apparel Manufacturing Apparel Knitting Mills Cut and Sew Apparel Contractors Men’s & Boys’ Cut & Sew Apparel Mfg. Women’s & Girls’ Cut & Sew Apparel Mfg. Other Cut & Sew Apparel Manufacturing Apparel Accessories & Other Apparel Mfg. Leather & Allied Product Manufacturing Leather & Hide Tanning & Finishing Footwear Manufacturing (including rubber & plastic) Other Leather & Allied Product Mfg. Wood Product Manufacturing Sawmills and Wood Preservation Veneer, Plywood, & Engineered Wood Product Manufacturing Other Wood Product Manufacturing Paper Manufacturing Pulp, Paper, & Paperboard Mills Converted Paper Product Manufacturing Printing and Related Support Activities Book Printing Other Commercial Printing Petroleum and Coal Products Mfg. Petroleum Refineries (including integrated) Asphalt Paving, Roofing, & Saturated Materials Manufacturing Other Petroleum and Coal Products Mfg. Chemical Manufacturing Basic Chemical Manufacturing Resin, Synthetic Rubber & Artificial and Synthetic Fibers & Filaments Manufacturing Pesticide, Fertilizer, & Other Agricultural Chemical Manufacturing Pharmaceutical & Medicine Manufacturing Paint, Coating, & Adhesive Manufacturing Soap, Cleaning Compound, & Toilet Preparation Manufacturing Other Chemical Product & Preparation Mfg. Plastics and Rubber Products Mfg. Plastic Product Manufacturing Rubber Product Manufacturing Nonmetallic Mineral Product Mfg. Clay Product & Refractory Manufacturing Code 327210 Glass & Glass Product Manufacturing 327300 Cement & Concrete Product Mfg. 327400 Lime & Gypsum Product Manufacturing 327900 Other Nonmetallic Mineral Product Mfg. 331000 Primary Metal Manufacturing 331110 Iron and Steel Mills & Ferroalloy Mfg. 331200 Steel Product Manufacturing from Purchased Steel 331310 Alumina & Aluminum Production and Processing 331400 Nonferrous Metal (except Aluminum) Production & Processing 331500 Foundries 332000 Fabricated Metal Product Mfg. 332110 Forging and Stamping 332210 Cutlery and Handtool Manufacturing 332300 Architectural and Structural Metals Mfg. 332400 Boiler, Tank, & Shipping Container Mfg. 332510 Hardware Manufacturing 332610 Spring and Wire Product Manufacturing 332700 Machine Shops; Turned Product & Screw; Nut & Bolt Manufacturing 332810 Coating, Engraving, Heat Treating, & Allied Activities 332900 Other Fabricated Metal Product Mfg. 333000 Machinery Manufacturing 333100 Agricultural, Construction, & Mining Machinery Manufacturing 333200 Industrial Machinery Manufacturing 333310 Commercial & Service Industry Machinery Manufacturing 333410 Ventilation, Heating, Air-Condtioning, & Commercial Refrigeration Equipment Mfg. 333510 Metalworking Machinery Manufacturing 333610 Engine, Turbine, & Power Transmission Equipment Manufacturing 333900 Other General Purpose Machinery Mfg. 334000 Computer and Electronic Product Mfg. 334110 Computer & Peripheral Equipment Mfg. 334200 Communications Equipment Manufacturing 334310 Audio and Video Equipment Manufacturing 334410 Semiconductor & Other Electronic Component Manufacturing 334500 Navigational, Measuring, Electromedical, & Control Instruments Manufacturing 334610 Manufacturing & Reproducing Magnetic & Optical Media 335000 Electrical Equipment, Appliance, & Component Manufacturing 335100 Electric Lighting Equipment Manufacturing 335200 Household Appliance Manufacturing 335310 Electrical Equipment Manufacturing 335900 Other Electrical Equipment & Component Manufacturing 336000 Transportation Equipment Mfg. 336110 Motor Vehicle Mfg./Auto Light Duty 336210 Motor Vehicle Body & Trailer Mfg. 336300 Motor Vehicle Parts Manufacturing 336410 Aerospace Product & Parts Manufacturing 336510 Railroad Rolling Stock Manufacturing 336610 Ship and Boat Building 336990 Other Transportation Equipment Mfg. 337000 Furniture and Related Product Mfg. 339000 Miscellaneous Manufacturing 339110 Medical Equipment & Supplies Mfg. 339900 Other Miscellaneous Manufacturing Mining (210000) 211110 Oil and Gas Extraction 212110 Coal Mining 212200 Metal Ore Mining 212310 Stone Mining and Quarrying 212320 Sand, Gravel, Clay, & Ceramic and Refractory Minerals Mining & Quarrying American LegalNet, Inc. www.FormsWorkflow.com North American Industry Classification System (continued) Code 212390 213110 Other Nonmetallic Mineral Mining & Quarrying Support Activities for Mining Other Services (810000) (except public administrtion) 811000 Repair and Maintenance 811110 Automotive Mechanical & Electrical Repair & Maintenance 811120 Automotive Body, Paint, Interior, and Glass Repair 811190 Other Automotive Repair & Maintenance (including oil change & lubrication shops & car wash) 811210 Electronic & Precision Equipment Repair and Maintenance 811310 Commercial & Industrial Machinery and Equipment (except Automotive & Electronic) Repair & Maintenance 811410 Home & Garden Equipment and Appliance Repair & Maintenance 811420 Reupholstery & Furniture Repair 811430 Footwear & Leather Goods Repair 811490 Other Personal & Household Goods Repair & Maintenance 812000 Personal and Laundry Services 812111 Barber Shops 812112 Beauty Shops 812113 Nail Salons 812190 Other Personal Care Services (including diet & weight reducing centers) 812210 Funeral Homes and Funeral Services 812220 Cemeteries and Crematories 812300 Drycleaning & Laundry Services 812310 Coin-Operated Laundries and Drycleaners 812320 Drycleaning and Laundry Services (except Coin-Operated) 812330 Linen and Uniform Supply 812910 Pet Care (except Veterinary) Services 812920 Photofinishing 812930 Parking Lots and Garages 812990 All Other Personal Services Professional, Scientific, & Technical Services 541100 Legal Services 541110 Offices of Lawyers 541190 Other Legal Services 541200 Accounting, Tax Preparation, Bookkeeping, and Payroll Services 541211 Offices of Certified Public Accountants 541213 Tax Preparation Services 541214 Payroll Services 541219 Other Accounting Services 541300 Architectural, Engineering, and Related Services 541310 Architectural Services 541320 Landscape Architectural Services 541330 Engineering Services 541340 Drafting Services 541350 Building Inspection Services 541360 Geophysical Surveying & Mapping Services 541370 Surveying & Mapping (except Geophysical) Services 541380 Testing Laboratories 541400 Specialized Design Services (including interior, industrial, graphic, & fashion design) 541500 Computer Systems Design & Related Services 541511 Custom Computer Programming Services 541512 Computer Systems Design Services 541513 Computer Facilities Management Services 541519 Other Computer Related Services 541600 Management, Scientific, & Technical Consulting Services 541610 Management Consulting Serivces Code 541700 541800 541860 541900 541910 541920 541930 541940 541990 551000 551111 551112 Scientific Research & Development Services Advertising and Related Services Direct Mail Advertising Other Professional, Scientific, and Technical Services Marketing Research and Public Opinion Polling Photographic Services Translation and Interpretation Services Veterinary Services All Other Professional, Scientific, and Technical Services Management of Companies and Enterprises Offices of Bank Holding Companies Office of Other Holding Companies Public Administration 920000 921000 Public Administration Executive, Legislative and Other General Government Support Real Estate and Rental and Leasing (530000) 531000 531110 531120 531130 531190 531210 531310 531320 531390 532000 532100 532210 532220 532230 532290 532291 532310 532400 532420 533110 Real Estate Lessors of Residential Buildings and Dwellings Lessors of Nonresidential Buildings (except Miniwarehouses) Lessors of Miniwarehouses and Self- Storage Units Lessors of Other Real Estate Property Offices of Real Estate Agents & Brokers Real Estate Property Managers Offices of Real Estate Appraisers Other Activities Related to Real Estate Rental and Leasing Services Automotive Equipment Rental & Leasing Consumer Electronics & Appliances Rental Formal Wear and Costume Rental Video Tape and Disc Rental Other Consumer Goods Rental Home Health Equipment Rental General Rental Centers Commercial and Industrial Machinery & Equipment Rental & Leasing Office Machinery and Equipment Rental and Leasing Lessors of Nonfinancial Intangible Assets (except Copyrighted Works) Religious, Grantmaking, Civic, Professional and Similar Organizations 813000 Religious, Grantmaking, Civic, Professional, & Similar Organizations Retail Trade 441000 441110 441120 441210 441221 441222 441229 441300 442000 442110 442210 442291 442299 Motor Vehicle and Parts Dealers New Car Dealers Used Car Dealers Recreational Vehicle Dealers Motorcycle Dealers Boat Dealers All Other Motor Vehicle Dealers Automotive Parts, Accessories, & Tire Stores Furniture & Home Furnishings Stores Furniture Stores Floor Covering Stores Window Treatment Stores All Other Home Furnishings Stores Code 443000 443111 443112 443120 443130 444100 444110 444120 444130 444190 444200 445000 445100 445110 445120 445200 445210 445220 445230 445291 445292 445299 445310 446000 446110 446120 446130 446190 447100 447100 448000 448110 448120 448130 448140 448150 448190 448210 448310 448320 451000 451110 451120 451130 451140 451211 451212 451220 452000 452110 452900 453000 453110 453210 453220 453310 453910 453920 453930 453990 454000 454110 454210 454311 454312 Electronics and Appliance Stores Household Appliance Stores Radio, Television, & Other Electronics Stores Computer and Software Stores Camera and Photographic Supplies Stores Building Material & Garden Equipment and Supplies Dealers Home Centers Paint and Wallpaper Stores Hardware Stores Other Building Material Dealers Lawn & Garden Equipment & Supplies Stores Food and Beverage Stores Grocery Stores Supermarkets and Other Grocery (except Convenience) Stores Convenience Stores Specialty Food Store Meat Markets Fish and Seafood Markets Fruit and Vegetable Markets Baked Goods Stores Confectionery and Nut Stores All Other Specialty Food Stores Beer, Wine, and Liquor Stores Health and Personal Care Stores Pharmacies and Drug Stores Cosmetics, Beauty Supplies, & Perfume Stores Optical Goods Stores Other Health & Personal Care Stores Gasoline Stations Gasoline Stations (including convenience stores with gas) Clothing and Clothing Accessories Stores Men’s Clothing Stores Women’s Clothing Stores Children’s & Infants’ Clothing Stores Family Clothing Stores Clothing Accessories Stores Other Clothing Stores Shoe Stores Jewelry Stores Luggage & Leather Goods Stores Sporting Goods, Hobby, Book, and Music Stores Sporting Goods Stores Hobby, Toy, and Game Stores Sewing, Needlework, & Piece Goods Stores Musical Instrument & Supplies Stores Book Stores News Dealers and Newsstands Prerecorded Tape, Compact Disc, and Record Stores General Merchandise Stores Department Stores Other General Merchandise Stores Miscellaneous Store Retailers Florists Office Supplies & Stationery Stores Gift, Novelty, and Souvenir Stores Used Merchandise Stores Pet and Pet Supplies Stores Art Dealers Manufactured (Mobile) Home Dealers All Other Miscellaneous Store Retailers (including tobacco, candle, & trophy shops) Nonstore Retailers Electronic Shopping & Mail-Order Houses Vending Machine Operators Heating Oil Dealers Liquefied Petroleum Gas (Bottled Gas) Dealers American LegalNet, Inc. www.FormsWorkflow.com North American Industry Classification System (continued) Code 454319 4