Form Ifta-1 - International Fuel Tax Agreement (Ifta) - 2001
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1
2
3
4Registration Data
Renewal
New
MASSACHUSETTS DEPARTMENT OF REVENUE
Additional
2001 INTERNATIONAL FUEL TAX AGREEMENT (IFTA)
MASSACHUSETTS LICENSE APPLICATION
Registration Period 1/1/2001 through 12/31/2001
1 Federal Employer Identification Number/Social Security Number
MA
2 Legal Name of Business
3 Trade Name (DBA)
4 Business Address (Number and Street)
5 Mailing Address for license/decals/returns
City
State
Zip Code
City
State
Zip Code
Business Telephone Number
(
)
–
6 USDOT Number:
7 IRP Account Number:
8 Office where fuel records are available for audit (if different from 4 and 5)
9 Name of representative or agent
Telephone Number
(
)
–
Street Address
City
State
ZIP Code
10 Date you began or will begin IFTA in Massachusetts (under your current Identification Number)
11 Type of Business
Partnership
Individual
Corporation
Other (specify)
12 Names, titles, social security numbers and residence addresses of principal officers of corporation or of members, partners,
owners, etc.
Name
Title
Social Security Number
Number & Street
City or town, state, ZIP code
Two decals are needed for each vehicle
Decal Order
13 Number of IFTA vehicles ______________ x $8 cost per set =
$
Remit fees with application. Remittance must be in U.S. funds.
Make check payable to: Commonwealth of Massachusetts
Complete items on reverse and be sure to sign this application.
Mail to: IFTA Processing Section, P.O. BOX 7027, Boston, Ma. 02204. (617) 887–5080
IFTA-1
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