Form Ohif 1 - Application For International Fuel Tax Agreement (Ifta) License 2006 (Page 2 of 2) in pdf

OHIF 1

P.O. Box 530

Columbus, OH 43216-0530

Rev. 10/06

(614) 466-3921

Fax (614) 728-8085

Page 2

Application for International Fuel Tax Agreement (IFTA) License Instructions

Special Instructions: Please print or type when completing

12. If you are registered with the Federal Motor Carrier Safety

form.

Administration (FMCSA), enter the USDOT number that

has been assigned to you.

1. List federal employer identification number (FEIN). Only

list Social Security number (SSN) if sole owner or

13. IRP (International Registration Plan) account number and

partnership.

base state. List IRP number and base state here.

2. Please check appropriate box to indicate reason for

14. and 15. Check “Yes” or “No” and indicate the state or

application.

account number where appropriate.

3. Please check appropriate box to indicate type of

16. List each state in which you maintain bulk fuel storage.

ownership.

17. Enter requested number of sets of decals. Order only as

4. Print the legal name of the business (partnership, limited

many sets as needed. You are required to account for

liability company or corporate name). If the business is a

every decal issued to you for the current year and the

sole proprietorship, indicate complete name (last, first

previous three years. Decals will be mailed to the address

and middle name).

shown on line 6 (or line 7, if completed) within five working

days of receipt of this application. Please mail the form

5. Print the trade name or registered business name (DBA)

to the above address or fax to (614) 728-8085.

only if different than the legal business name.

18. Signature – Every licensee shall file quarterly tax returns

6. Print the physical location of the business (P.O. boxes

and maintain records to support information on the tax

are not acceptable).

returns. The tax returns are due on the last day of the

month following the calendar quarter. The records must

7. Print the mailing address of the business only if different

be maintained for a period of four years from the due date

from line 5.

of the return. The records must be available to the Ohio

8. List the first and last name of a contact person should

Department of Taxation upon request.

there be any questions concerning your application and/

19. OPTIONAL – Should be completed only if you are

or account.

requesting a temporary authority. If you need

9. Print the Ohio county in which your business is located.

immediate authority to run, check “Yes” to have temporary

authority faxed to you at the fax number shown on line

10. If corporation, LLC, LLP, LP or partnership, please list

11.

the name, address and Social Security number for each

officer or partner. Use a separate sheet if more space is

20. Do not complete this section until stamped in bottom

needed. The requirement for each officer or partner’s social

corner of page 1 (Temporary Authority Use Only).

security number is per Ohio Revised Code (ORC) 5728.02.

Upon receipt of validated (stamped) temporary authority,

enter the vehicle identification number in the space

11. Business telephone number, fax number and secondary

provided on line 20. Note: You may reproduce a validated

telephone number of contact person (i.e., cell phone).

temporary authority for up to the number of sets of decals

requested on line 17. A temporary authority is valid for 30

days from the date of issue.

Federal Privacy Act

Because we require you to provide us with a Social Security

need your Social Security number in order to administer this

number, the Federal Privacy Act of 1974 requires us to in-

tax. Your failure to supply any information requested on a

form you that your providing us your Social Security number

tax form prescribed by the tax commissioner may result in

is mandatory. Ohio Revised Code sections 5703.05, 5703.057

(i) the imposition of penalties for failing to file a complete tax

and 5747.08 authorize us to request this information. We

return or (ii) the denial of a license, if applicable.

Form Ohif 1 - Application For International Fuel Tax Agreement (Ifta) License 2006 Page 2

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