2008 Ifta Renewal Registration Application
ADVERTISEMENT
1
210/07
GEORGIA DEPARTMENT OF REVENUE
Motor Vehicle Division/IFTA
OFFICE USE ONLY
P.O. BOX 161029
CITATION AMOUNT
ATLANTA, GA 30321-1029
(PLEASE PRINT OR TYPE
$
2008 IFTA RENEWAL REGISTRATION APPLICATION
(READ INSTRUCTIONS ON BACK BEFORE COMPLETING)
Note: STI and IFTA account # are required
for online RENEWAL
STATE TAXPAYER IDENTIFIER
GA IFTA ACCOUNT NO. **
DBA NAME (Required)
LOCATION ADDRESS (Required)
LEGAL BUSINESS NAME
TELEPHONE NO.
DO YOU HAVE BULK FUEL
FEI OR SSN (Required)
(
)
-
STORAGE? (Required) YES OR NO
USDOT NUMBER (Required)
IRP NUMBER & STATE (Required)
HAVE YOU EVER BEEN LICENSED UNDER IFTA IN ANOTHER STATE? (
) Yes (
) No
IF YES WHICH STATE?
IFTA MOTOR CARRIER IDENTIFICATION MARKERS
NUMBER OF CNG (NATURAL GAS) POWERED VEHICLES
NUMBER OF DIESEL POWERED VEHICLES
NUMBER OF GASOLINE POWERED VEHICLES
NUMBER OF LP POWERED VEHICLES
OTHER
$
TOTAL NUMBER OF IFTA MOTOR CARRIER SETS:
X $ 3.00 PER SET =
DECLARATION STATEMENT
The applicant agrees to comply with reporting record keeping and license requirements as specified in the Georgia IFTA Procedures Manual. The
applicant authorizes the State of Georgia to withhold any refund of tax overpayment, if delinquent taxes are due any IFTA jurisdiction member.
Failure to comply with these provisions shall be grounds for revocation or suspension of the license in all member states.
Application, certifies with his signature that to the best of his knowledge, the information is true, accurate and complete and any falsification subject s
him to the offense of making a written false statement to a government official.
*Signature
Title
Date
*
( Must be signed by Owner, Partner, or Authorized Officer of Corporation – Stamped signature unacceptable)
** IF YOUR IFTA ACCOUNT NUMBER BEGINS OR ENDS IN 90, PLEASE SEE SPECIAL INSTRUCTIONS
The 2008 IFTA License and Decals will be mailed on or after December 1, 2007.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial