In accordance with existing Special Fuel Use Tax Law of Oklahoma, the above named applicant hereby makes application to the Oklahoma Tax Commission for a Special Fuel License.

If foreign corporation, give below, name and address of person on whom service may be had in Oklahoma:

Names and addresses of principal manufacturers, refiners or jobbers from whom purchases of special fuel will be made:

Are you engaged in the business of handling special fuel in Oklahoma and delivering any part thereof into the fuel supply tanks of motor vehicles?

Description of storage and dispensing facilities from which special fuel will be delivered into fuel tanks of motor vehicles:

AGREEMENT

It is hereby agreed by the applicant, in consideration of the issuance of a Special Fuel Dealer and/or User License to the applicant by the Oklahoma Tax Commission, and as conditions of the license, that:

The applicant will adopt, make and keep records as required by law and the rules and regulations of the Oklahoma Tax Commission showing the purchases, receipts, inventories, sales, deliveries and use of all special fuel including the required delivery invoices, covering all receipts, purchases, sales, deliveries and use which records and invoices shall be subject to audit and examination at any time by the representatives of the Oklahoma Tax Commission and shall be kept for a period of at least three years on the premises at the address set out in the application.

The applicant will, on or before, the 20th day of each month, make all reports on forms furnished by the Oklahoma Tax Commission, for the preceding month, required by law and the rules and regulations of the Oklahoma Tax Commission and at time of filing report will pay all special fuel use taxes shown due by such reports.

The applicant will transact his business in all respects in accordance with the special fuel use law of this state and the rules and regulations of the Oklahoma Tax Commission.

Upon receipt of notice of cancellation, by an order of the Oklahoma Tax Commission duly entered on its records after notice to him and a hearing thereon, of any license issued to him, the applicant will surrender such license and discontinue business operations thereunder as provided by law.

The undersigned has read the above agreement and each and every particular thereof and agrees to each condition upon which the license is issued.

Applicant further states that all matter and facts set forth in the foregoing application are true and correct.

for a special fuel dealer's and/or user's license within the State of Oklahoma, came on to be heard. The amount of bond to secure the excise tax accruing, for which the above named applicant may become liable, is hereby fixed at $

to be approved by the Oklahoma Tax Commission.

Therefore, it is ordered by the Oklahoma Tax Commission that this application be approved and upon the filing and approval of a bond in the above amount that the within named applicant be granted a special fuel license, in conformity with existing Oklahoma Special Fuel Use Tax Laws.

DEALER-USER

in accordance with the Oklahoma Special Fuel Tax Law hereby makes application to the Oklahoma Tax Commission for a Special Fuel Use Vehicle Permit for

the vehicles listed below, which are owned or operated by the applicant.

(NAME)

(OVER)

SIGN APPLICATION BEFORE MAILING

(NAME OF SPECIAL FUEL USER)

OTC LICENSE NO.

That the undersigned has read the foregoing application, knows the contents thereof, and that the statements therein contained are true and correct.

a corporation duly incorporated under the laws of... and authorized to transact business within the State of Oklahoma, as Surety, are all held and firmly bound unto the State of Oklahoma, and to the Oklahoma Tax Commission as the official collector of the special fuel use excise tax levied by the laws of the State of Oklahoma, in the sum of...... ...) for the payment

Dollars, ($.

of which, well and truly to be made, the said Principal and Surety bind themselves, their successors, heirs and assigns, jointly and severally, by these presents:

THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH, that,

WHEREAS, the said Principal is a dealer in and/or user of special fuel in the State of Oklahoma, as defined by the laws of the State of Oklahoma;

NOW, THEREFORE, if the said Principal shall, while this bond is in force and effect, beginning at noon, Central Standard Time, on the... ..day of..... 19........, make and file with the Oklahoma Tax Commission, the reports and details of the use of and transactions in special fuel required by law, and by the rules and regulations of the Oklahoma Tax Commission; and shall well and truly pay, or cause to be paid, any and all special fuel use excise taxes, interest and penalties thereon, due the State of Oklahoma, (the amount due to be ascertained by the Oklahoma Tax Commission, whose finding shall be final and conclusive in any action upon said bond to enforce liability thereunder), and shall comply with all the provisions of the special fuel use tax law and the rules and regulations of the Oklahoma Tax Commission; then this obligation shall be null and void; otherwise, to remain in full force and effect.

This bond is a continuing bond, and may be terminated by the surety, upon its giving thirty (30) days notice of its intention of termination, such notice to be filed with the Oklahoma Tax Commission.

IN TESTIMONY WHEREOF, the said Principal has executed this bond by signing his name hereto, or caused it to be signed by its President, and attested by its Secretary, and its corporate seal to be hereto affixed; or the said Surety has caused its corporate seal to be hereunto affixed and by signing his name as Attorney-in-Fact.