Form Ifta-100-Mn - Ifta Quarterly Fuel Use Tax Report - 2000
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1Georgia Dept of Revenue
IFTA-100-MN
419 Trinity Washington Bldg
Atlanta, GA 30334
Use this form to report operations for the
Phone: (404) 656-4055
quarter ending
Month
Day
Year
This report must be filed by the
last day of the month following
the end of the quarter.
Licensee IFTA Identification Number
GA
Name
Address Change
Street Address
No operation in
any jurisdiction
City
State
Zip Code
Cancel License
Amended Report
IFTA Quarterly Fuel Use Tax Report
File this report even if there is no tax due.
Use this form for filing your Quarterly Fuel Use Tax Report as required under the International Fuel Tax Agreement (IFTA).
Read the instructions on the back carefully. Make a copy of this report for your records.
Enter the amount of
Attach check or money order payable to:
your payment here
GEORGIA DEPARTMENT OF REVENUE.
$
See Mailing Instructions on the back of this form.
Enter the Total from column Q for Form IFTA-101-MN, IFTA Quarterly Fuel Use Tax Schedule, for fuel types listed in lines 1
thru 4. For all other fuel types enter the Total Amount from column S of the worksheet on back of Form IFTA-101-MN.
Enter any credit amounts in brackets. Attach a Form IFTA-101-MN for each fuel type reported below.
1
1 Diesel..........................................................................................................................................
2
2 Motor fuel gasoline......................................................................................................................
3
3 Ethanol.......................................................................................................................................
4
4 Propane (LPG)............................................................................................................................
5
5 All other fuel types not listed in lines 1 thru 4 (from worksheet on back of IFTA-101-MN).............
6
6 Subtotal of amount due or (credit) (add lines 1 through 5)............................................................
7
7 Penalty (see instructions)............................................................................................................
8
8 Total balance due or (credit) (add lines 6 and 7)...........................................................................
9
9 Credits to be applied....................................................................................................................
10
10 Balance due/(credit) (subtract line 9 from line 8)...........................................................................
11
11 Refund amount requested............................................................................................................
I certify that this business is duly licensed and that this report, including any schedules,
For Office Use Only
is to the best of my knowledge and belief true, correct and complete.
Sig
Corr
Name/ID
Authorized signature
Date
Taxpayer’s phone number
(
)
Paid preparer’s EIN
Official title
Paid preparer’s name or firm (if other than taxpayer)
Paid preparer’s phone number
(
)
Paid preparer’s address
GA
Date
Paid preparer’s signature
Date Received
Please make a copy of this report for your records.
IFTA-100-MN (3/99) (rev. 12/00)
00
See Mailing Instructions on back.
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