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                         Department of Taxation and Finance

                         Application for Highway Use Tax (HUT) and Automotive Fuel                                                                             TMT-1(4/16) 
                         Carrier (AFC) Certificates of Registration (C of R) and Decals

              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 office use only
You mustcomplete        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 fill-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  Identification        Employer identification number           Suffix, if any             Social security number (SSN) 
    number
                                                                                   OR                                                      SS
    2USDOT number       3  Telephone number                        4  E-mail address                                                                 5  Fax number

    6Legal name                                                                             7  Doing business as (DBA) name, if different from legal name

    8Physical 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  Xin 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 identification 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  Xin 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 officer 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 officer, 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, officer, member or individual with a Power of Attorney on file with the New York State Tax Department
       Certification: 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 fine 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
                                                                                                                                  HUT/IFTA APPLICATION DEPOSIT UNIT
       Make check or money order payable in U.S. funds to Commissioner of  Taxation and Finance.                                  W A HARRIMAN CAMPUS
                                                                                                                                  ALBANY NY 12227-0863



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              in  X   
                                                                                                                                            SS                                                                                                                                                                                                                                                                                                                                                                           L
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     box if
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Mark                                                                     temporary          plate no.

                                                                                                                                                                                          Form TMT-1.1,                                                                                                                                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         K 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Plate number
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     plate number 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              (required; see instr.)                                                           
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           State and license 
                                                                                               Social security number (SSN)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   State
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                                                                                                                            OR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         J 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Owner                                                                     number                                       ( optional )
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     equipment 

                                                                                               Suffix, if any 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         I                           or                                                                                                                                     Own                              Lease                                  Own                          Lease                           Own                             Lease                           Own                             Lease                           Own                             Lease                           Own                             Lease                               Own                             Lease                               Own                             Lease                           Own                             Lease                           Own                             Lease
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Own                                                                       lease 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         H 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Gross                     weight 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     of vehicle 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         G 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     weight 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Unloaded                                                                  of vehicle 
                                                                                               Employer identification number
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         F                                                                            
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Year 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         E                                                                            
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Make of                   vehicle 
                                                                                               Taxpayer                      identification       number

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            CNG                   Electric           Flex            Other           CNG              Electric           Flex            Other           CNG          Electric           Flex            Other           CNG          Electric           Flex            Other           CNG          Electric           Flex            Other           CNG          Electric           Flex                Other           CNG          Electric           Flex                Other           CNG          Electric           Flex            Other           CNG          Electric           Flex            Other           CNG          Electric           Flex                             Other
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         D                           fuel 
When printing, select "Auto portrait/landscape" in the Orientation section.                                                                                                                                                                                                                                                                                                                                                                                                                                                Type of 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Diesel                Gas                Propane         None            Diesel           Gas                Propane         None            Diesel       Gas                Propane         None            Diesel       Gas                Propane         None            Diesel       Gas                Propane         None            Diesel       Gas                Propane             None            Diesel       Gas                Propane             None            Diesel       Gas                Propane         None            Diesel       Gas                Propane         None            Diesel       Gas                Propane                          None

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         C                                                                            
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Type of                   vehicle                                                                                                                       Tractor                   Truck                   Trailer (AFC)          Tractor              Truck                   Trailer (AFC)   Tractor                 Truck                   Trailer (AFC)   Tractor                 Truck                   Trailer (AFC)   Tractor                 Truck                   Trailer (AFC)   Tractor                 Truck                       Trailer (AFC)   Tractor                 Truck                       Trailer (AFC)   Tractor                 Truck                   Trailer (AFC)   Tractor                 Truck                   Trailer (AFC)   Tractor                 Truck                     Trailer (AFC)

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

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         B 

                                                                            (4/16)                                                                                                                                                                                                                                                                                                                                                                                                                                         Manufacturer’s                                                            number (  VIN  ) 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     vehicle identification  

                                                                            TMT-1 
                                                                             
                                                                             of 2                                                                                                                                                                                                                                                                                                                                                                                                                                        A                                                                                                                                                                  HUT                              AFC                            HUT                                  AFC                            HUT                              AFC                            HUT                              AFC                            HUT                              AFC                            HUT                                    AFC                          HUT                                    AFC                          HUT                              AFC                            HUT                              AFC                            HUT                                   AFC
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Type 
                                                                                                                                                                                          Credentials are requested for the following vehicles. List each vehicle separately. Group trucks, tractors, and automotive fuel carrier trailers separately. For additional vehicles, use                                  Continuation Sheet for Form TMT-1
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                                                                            Page 2  Legal name                                                                                                                                                                                                                                                                                       17                                                                                              Type or print your entries in ink.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                10






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