Form Ohif 1 - Application For International Fuel Tax Agreement (Ifta) License Form - 2010
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hio
Department of
Offi ce Use Only
Taxation
P.O. Box 530
OHIF 1
Columbus, OH 43218-0530
Rev. 7/10
tax.ohio.gov
Application for International Fuel Tax Agreement (IFTA) License
1. Reason for application: Additional decal(s)
New account
Account update/change
Replacement decal
Renewal
2. Federal ID number (FEIN)
(if FEIN doesn’t exist, enter Social Security number of owner)
2a. Business structure: Sole owner Partnership Corporation LLC LLP LP
3. Legal name
(If sole owner, enter owner’s name as last name, fi rst name and middle initial)
4. Doing business as (DBA)
5. Physical address
Street
City
State
ZIP code
5a. Ohio county of physical address
6. Mailing address
Street
City
State
ZIP code
7. If corporation, LLC, LLP, LP or partnership, list names of offi cers or partners below.
I.
II.
(last name, fi rst name)
(last name, fi rst name)
8. Primary contact name
Alternate contact name
9. Business number
Fax number
Cell number
10. Will you be traveling outside the state of Ohio? Yes No
11. Have you ever had an IFTA license from a state other than Ohio? Yes No If yes, what state?
12. Do you have bulk fuel? Yes No If yes, in what state(s)?
13. How many sets (one set equals two decals) of decals are you requesting for IFTA qualifi ed vehicles?
14. Do you wish to have temporary authority faxed to you? Yes No
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge, it is correct
and complete. I further agree to comply with reporting, payment, record-keeping and license display requirements as
specifi ed in the International Fuel Tax Agreement. I authorize the state of Ohio to withhold any refund or tax overpayment
if delinquent taxes are due any member IFTA jurisdiction. Failure to comply with these provisions shall be grounds for
revocation of the IFTA license in all member jurisdictions.
15.
Signature
Date
Fax completed application to: (614) 728-8085
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