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

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OHIF-1
Revised 7/03
Application for International Fuel Tax Agreement (IFTA) License
1. Federal ID or social security number
2. Legal name
Last
First
Middle
3. Trade name
4. Physical address
Street
City
State
ZIP code
5. Mailing address
Street
City
State
ZIP code
6. Contact name
7. Ohio county
8. Type of ownership:
Individual
Partnership
Corporation
LLC
LP
LLP
Other
9. If corporation, LLC, LLP, LP or partnership, list names, addresses and social security numbers of officers or partners.
Name
Street
City
State
ZIP code
Social security number
Name
Street
City
State
ZIP code
Social security number
10. Internet e-mail address
11. Telephone number
Fax number
12. United States D.O.T. number
13. IRP (apportioned tag) account no.
IRP base state
14. Have you ever held an Ohio Fuel Use Tax account?
Yes
No If yes, list account number
15. Have you ever had an IFTA license from a state other than Ohio?
Yes
No If yes, what state?
16. Has your IFTA license ever been revoked?
Yes
No If yes, in what state?
17. List all states in which you maintain bulk fuel storage
18. Number of decals needed
19. Do you wish to have a temporary authority faxed to you?
Yes
No
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 below 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.
For Temporary Authority Use Only
20.
Vehicle Identification Number
Base Jurisdiction
Ohio
Effective date
Valid through
Under penalties of perjury, I declare that I have examined this application, and to the
Temporary Permit NOT Valid
best of my knowledge, it is correct and complete. I further agree to comply with reporting,
Unless Stamped
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.
21.
Signature
Date

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