Form Ct-Ifta-2 - Application For International Fuel Tax Agreement (Ifta) License Connecticut Carrier - 2016


Department of Revenue Services
Calendar Year
State of Connecticut
PO Box 2937
Application for International Fuel Tax
If registered, enter
Hartford CT 06104-2937
Agreement (IFTA) License Connecticut Carrier
Connecticut Tax Registration Number
(Rev. 12/15)
Do not use this application to request Connecticut motor carrier road tax decals. Complete
REG-3-MC, Application for Motor Carrier Road Tax for motor carrier road tax decals.
Check if your mailing address
Complete this form in blue or black ink only. Please read all instructions on back before completing.
has changed and indicate new address.
1. Reason for applying
New account
Registration of additional vehicles
Other: Explain
2. Name of owner, partnership, corporation, or LLC
Federal Employer ID Number (FEIN)
3. Trade name or registered name, if different from Line 2
Social Security Number (SSN)
4. Physical location of this business: PO Box is not acceptable
ZIP plus 4
Telephone number
5. Mailing address of this business, if different from Line 4
ZIP plus 4
United States DOT Number
6. Name and home address of owner, partner, corporate offi cer, or LLC member
ZIP plus 4
7. Names and home addresses of other partners, corporate offi cers, or LLC members
ZIP plus 4
8. Type of ownership: If Other, attach explanation.
Sole proprietor
General partnership
Limited partnership
S corporation
Limited liability company (LLC)
Single member LLC
8a. Organized under laws of what state?
 
Check if taxed as a corporation
Check if taxed as a corporation
9. Are you currently or have you been registered with another jurisdiction under IFTA?
If Yes, enter the name of the jurisdiction.
10. Describe in detail the type of business you operate.
11. Do you store fuel in bulk?
If Yes, where is the fuel stored? ____________________________________________
11a. Types of fuel used
_____ Special Diesel ____ Gasoline
_____ Ethanol
_____ Propane
_____ A-55
_____ E-85
_____ M-85
_____ Gasohol
_____ LNG
_____ Methanol
12. Contact Information
Contact Name
Email Address
13. Enter X for the jurisdictions in which you operate or anticipate operating:
_____AB - Alberta
_____AL - Alabama
_____IA - Iowa
_____NE - Nebraska
- Rhode Island
_____BC - British Columbia
_____NB - New Brunswick
_____AZ - Arizona
_____KS - Kansas
_____NV - Nevada
_____SC - South Carolina
_____MB - Manitoba
_____AR - Arkansas
_____KY - Kentucky
_____NH - New Hampshire
_____SD - South Dakota
_____ON - Ontario
_____CA - California
_____LA - Louisiana
_____NJ - New Jersey
_____TN - Tennessee
_____TX - Texas
_____QC - Quebec
_____CO - Colorado
_____ME - Maine
_____NM - New Mexico
_____CT - Connecticut
_____UT - Utah
_____SK - Saskatchewan
_____MD - Maryland
_____NY - New York
_____DE - Delaware
_____NC - North Carolina
_____VA - Virginia
_____NL - Newfoundland
_____MA - Massachusetts
_____FL - Florida
_____MI - Michigan
_____ND - North Dakota
_____VT - Vermont
_____NW - NW Territory
_____GA - Georgia
_____MN - Minnesota
_____OH - Ohio
_____WA - Washington
_____NS - Nova Scotia
_____PE - Prince Edward Isle
_____ID - Idaho
_____MS - Mississippi
_____OK - Oklahoma
_____WV - West Virginia
_____YU - Yukon Territory
- Illinois
_____MO - Missouri
_____OR - Oregon
_____WI - Wisconsin
_____WY - Wyoming
_____DC - District of Columbia
_____IN - Indiana
_____MT - Montana
_____PA - Pennsylvania
14. Fees: All applicants must
Enter total number of qualifi ed vehicles to be
Number of qualifi ed vehicles
Amount due
complete this section.
X $10 =
Make check payable to Commissioner of Revenue Services
Declaration: I declare under the penalty of false statement that I have examined this application, CT-IFTA-2, and to the best of my knowledge and belief it is true, complete,
and correct. The applicant agrees to comply with reporting, payment, recordkeeping, and license display requirements as specifi ed in the International Fuel Tax Agreement (IFTA).
The applicant further agrees that base jurisdiction may withhold any refunds due if the applicant is delinquent in paying fuel taxes due any member jurisdiction. Failure to
comply with these provisions shall be grounds for revocation of the IFTA license. I understand that IFTA decals may not be transferred by me to another person, or from one
vehicle to another.
Signature of owner, partner, corporate offi cer, or LLC member
Decals are not transferable from vehicle to vehicle or from company to company.


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