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Gas-1274 Registration Application for

Part 1. Identifying InformationPage of Ownership:ProprietorshipCorporationFiduc iaryPartnershipLLPLLCO ther(Identify) Name (DBA Name) If a corporation or LLC, State of IncorporationSecretary of State NumberDate Attach copy of Articles of Incorporation, LLC or LLP Operating agreement , Charter, and Certificate of Authority To Do Location(Not Box Number)StreetCityZip CodeCountyStateTelephone NumberFax Address Street or BoxCityZip CodeState7. Email ContactNameTelephone NumberFax of Records (if different from the business location)StreetCityZip CodeStateEmail AddressStreet or BoxCityZip CodeState11. Reporting Service/Tax Preparer Mailing Address NameStreet or BoxCityZip Name and Mailing AddressNameStreet or BoxCityZip CodeStateLessee Name and Mailing Address NameEmail AddressEmail AddressComplete the following if vehicles are involved in a lease agreement .

Complete the following if vehicles are involved in a lease agreement. Attach copy of the lease agreement. Decal Only Please fill in the appropriate circle for the documents that should be mailed to your reporting service/Tax preparer. ... AB Alberta BC British Columbia NB New Brunswick NF Newfoundland and Labrador NS Nova Scotia ON Ontario OR ...

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  Agreement, Alberta, Lease, Lease agreement

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