Form Ohif-1 - Application For International Fuel Tax Agreement (Ifta) License printable pdf download

Excise and Motor Fuel Tax

P.O. Box 530

Columbus, Ohio 43216-0530

(614) 466-3921

Fax: (614) 728-8085

OHIF-1 (Rev. 03/01)

APPLICATION FOR INTERNATIONAL FUEL TAX AGREEMENT (IFTA) LICENSE

Special instructions: (PLEASE PRINT OR TYPE)

•

Item 15 - Enter the number of sets of permits needed. Order only as many as needed. You are required to account for every permit

issued to you for the current year and the previous 3 years. Permits will be mailed to the mailing address on line 4 (or line 5 if completed)

within two working days of receipt of this application. Please mail the form to the above address or fax it to the number shown above.

•

Item 16 - OPTIONAL - Should be completed only if you are requesting a temporary authority. If you need immediate authority to run, check

“yes” to have a temporary authority faxed to you at the fax number listed on line 9.

16A). Enter vehicle identification number upon receipt

of validated temporary authority. Note: You may reproduce a validated temporary authority for up to the number of permits requested on

line 15. A temporary authority is valid for 30 days.

•

Item 17 – Signature - Every licensee shall file quarterly tax returns and maintain records to support information on the tax returns. The tax

returns are due on the last day of the month following the calendar quarter. The records must be maintained for a period of four years from

the due date of the return. The records must be made available to the Ohio Department of Taxation upon request.

Federal Privacy Act

Because we are requesting your social security account number, the Federal Privacy Act of 1974 requires us to inform you that giving us your social security

number is mandatory. Our legal right to ask for this information is supported under the Tax Reform Act of 1986. Your social security number is needed for the Tax

Commissioner to administer this tax. Failure to supply any information requested on a tax form prescribed by the Tax Commissioner may result in the denial of

your license application, if applicable, or the imposition of penalties for failing to file a complete tax return.

Telephone: (614) 466-3921

Fax: (614) 728-8085

Federal ID or Social Security Number

APPLICATION FOR INTERNATIONAL FUEL TAX

AGREEMENT (IFTA) LICENSE

2) Legal Name ___________________________________________________________________________________________________

)

(LAST

(FIRST

(MIDDLE

3) Trade Name ___________________________________________________________________________________________________

4) Street Address ________________________________________________ ___________________________ ______ _____________

CITY

STATE

ZIP

5) Mailing Address ________________________________________________ __________________________ ______ _____________

CITY

STATE

ZIP

6) Contact Name ________________________________

7) Ohio County ___________________

Individual

Partnership

9) Phone Number (_____) _______ - ____________

Fax Number (______) ______ - ___________

Corporation

Other

10) Have you ever held an Ohio Fuel Use Tax Account?

If Yes, List Account Number

___________________________

11) Have you ever had an IFTA license from a state other than Ohio?

If Yes, What State?

_____________________

12) Has your IFTA license ever been revoked?

If yes, in what state?

_______________________

13) Identify owner, partners or corporate officers

(Name, Address, City, State, Zip and SSN)

A._____________________________________________________________________________ Social Security Number:________-______-_________

B._____________________________________________________________________________ Social Security Number:________-______-_________

14) List all states in which you maintain bulk fuel storage:

__________________________________________________________________

15)

FOR TEMPORARY AUTHORITY USE ONLY

Number of Permits Needed

16)

16A)

Do you wish to have a

VEHICLE IDENTIFICATION NUMBER

BASE JURISDICTION

OHIO

temporary authority

____________

Effective Date

Valid through

faxed to you?

If this is a temporary decal permit, it is issued under the terms of the International Fuel Tax Agreement and is valid for the vehicle described above in all IFTA

Jurisdictions. A copy of this temporary decal permit must be carried in the vehicle. This temporary decal permit is not valid unless accompanied by a copy of the

motor carrier’s IFTA license.

TEMPORARY PERMIT NOT VALID

UNLESS STAMPED

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 SPECIFIED 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.

17)

__________________________________________________________________________________________

SIGNATURE

DATE

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

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