Form R-5679 - International Fuel Tax Agreement (Ifta) Decal Request Form
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1R-5679 (3/06)
International Fuel Tax Agreement
(IFTA) Decal Request Form
Please print or type.
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❑
❑
Year
New Request
Renewal
Additional
Account Number
Legal Name
Trade Name
Current Mailing Address
City
State
ZIP
Contact Person
Telephone
List additional states for which you anticipate travel, if not previously reported:
List states where bulk fuel is stored, if any :
Request for Decals
Two IFTA decals are required for each Qualified Motor Vehicle operated. One decal must be placed on the passenger’s
side and one decal on the driver’s side of each vehicle. Additional decals for vehicles added to your fleet may be
purchased during the calendar year. Extra decals may also be purchased with this request.
“Qualified Motor Vehicle” means a motor vehicle used, designed, or maintained for transportation of persons or property and:
1. having two axles and a gross vehicle weight or registered gross vehicle weight exceeding 26,000 lbs.; or
2. having three or more axles regardless of weight; or,
3. is used in combination when the weight of such a combination exceeds 26,000 lbs.
“Qualified Motor Vehicle” does not include recreational vehicles.
The IFTA decal must be visible and placed on both sides of the exterior portion of the cab (buses may place the decal on
the driver’s side). Failure to display the decal in the required locations may subject the operator to citations and/or fines.
A copy of your IFTA license must be submitted with all requests for additional decals.
Number of Qualified Vehicles __________________
x 2 =
________________
Number of extra decals requested .......................................... ________________
Total number of decals requested .......................................... ________________
x $1.00 =
$ ______________
Mail request and payment to:
Louisiana Department of Revenue
Taxpayer Services Division/Excise Tax
P.O. Box 201
Baton Rouge, LA 70821-0201
Please contact this office at (225) 219-7656 or TDD (225) 219-2114 should you need further assistance.
FOR OFFICE USE ONLY
Number of decals issued
Serial numbers
Date of issue
Walk-in
8907
Issuer’s initials
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