Form 56-101, International Fuel Tax Agreement
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1
2AB CD
Be sure to print and sign your report.
PRINT FORM
CLEAR FIELDS
*5610100W121609*
56-101
Instructions in English
International Fuel Tax Agreement (IFTA)
(Rev.12-16/9)
b.
b
Fuel Tax Report
56180
Do not write in shaded areas.
Type or print.
Read instructions on back.
56180 Original
a. T Code
b
I
I
I
c. Texas taxpayer number
d. IFTA number
e. Filing period
f.
g. Due date
TX
indicate filing period
b
b
IMPORTANT
i.
h. Name and mailing address (Make any necessary name or address changes below.)
No Operation -
Blacken this box if you
did not operate a qualified motor vehicle(s)
1.
during the quarter.
b
Cancel License -
Blacken this box if you
are filing a final report and requesting your
2.
license be cancelled.
b
Address Change -
Blacken this box if your
mailing address has changed. Show changes
3.
next to preprinted information.
b
j.
k.
b
b
Items 1 through 6 -
Enter the total amounts from Item 4 of Form 56-102 for each fuel type.
Enter credit amounts in brackets < >. See instructions on back.
$
1.
Diesel total due, if applicable
1.
b
2.
Gasoline total due, if applicable
2.
b
3.
Ethanol total due, if applicable
3.
b
4.
Propane (LPG) total due, if applicable
4.
b
5.
Compressed Natural Gas (CNG) total due, if applicable
5.
b
6.
Other fuel type(s) total due, if applicable
6.
b
(Add Items 1 through 6.)
7.
Subtotal of amount due
7.
b
7
a.
Amount subject to penalty, if report is filed late
(Enter the total from Item 2 of all supplements. If less than 0, enter 0.)
7a.
* * * DO NOT DETACH * * *
Form 56-101 (Rev.12-16/9)
(See instructions on back.)
8.
Penalty, if due
8.
$
9.
TOTAL AMOUNT DUE AND PAYABLE
9.
b
Taxpayer name
AB
l.
m.
b
T Code
Taxpayer number
Period
b
b
b
I declare the information in this document and all attachments is true and correct
to the best of my knowledge and belief.
56020
Authorized agent
Preparer's name (Please print)
Make the amount in Item 9
Mail to: Comptroller of Public Accounts
payable to:
P.O. Box 149357
State Comptroller
Austin, TX 78714-9357
Daytime phone
Date
(Area code & number)
For information about International Fuel Tax Agreement,
call 1-800-252-1383. Details are also available online
111 A
at
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