International Fuel Tax Agreement (Ifta) Massachusetts License Application - 2013
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8MASSACHUSETTS DEPARTMENT OF REVENUE
2013 INTERNATIONAL FUEL TAX AGREEMENT (IFTA)
MASSACHUSETTS LICENSE APPLICATION
Registration Period 01/01/2013 through 12/31/2013
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}
Federal Employer Identification or
Social Security Number
2 US - DOT #
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Legal Name of Business
Trade Name (DBA)
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4
Business Address (Number and Street)
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Mailing Address for license/decals/returns
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City
State
Zip Code
City
State
Zip Code
Business Telephone Number
(
)
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Type of Business
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Corporation
Individual
Partnership
Other (specify)
Office where fuel records are available for audit (if different from 5 or 6)
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Name of representative or agent (Include Form M-2848 power of attorney)
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Yes
No
Telephone Number
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)
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Check Registration Box for which you are applying:
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Renewal
New
Additional
Note: If you are traveling ONLY in Massachusetts, no IFTA license is required.
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Date you began in the IFTA program or will begin:
__ __ / __ __ / __ __ __ __
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Names, titles, social security numbers and residence addresses of principal officers
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(President, Treasurer & Secretary) of corporation OR of members, partners, owners, etc.
Name
Title
Social Security #
Address
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President
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Treasurer
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Secretary
Type of fuel used (Check all that apply)
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Diesel
Biodiesel
Motor fuel gasoline
Ethanol
Propane (LPG)
CNG
A-55
E-85
M-85
Gasohol
LNG
Methanol
Decal Orders are printed as a set of two decals.
â
Number of IFTA vehicles_____________ X $8 cost per vehicle =
$
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â
Decals are not vehicle specific; extra decals can be ordered.
Remit fees with application. Remittance must be in U.S. funds.
Make check payable to:
Commonwealth of Massachusetts
Mail to: IFTA Operations Unit
PO Box 7027
Boston, MA 02204
Ph. (617) 887-5080
Official Use Only
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