Form Boe-400-Iy - Renewal Application For Ifta License And Decals Page 2
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2BOE-400-IY (BACK) REV. 6 (8-11)
STATE OF CALIFORNIA
BOARD OF EQUALIZATION
SECTION III: Cancellation Notice (complete this section if you will not be renewing your California IFTA License)
I am not renewing my IFTA license because (check only one box)
I am no longer in business. Date business discontinued:
I am no longer operating outside the state of California. Date of last interstate trip:
My truck(s) is/are leased to another carrier (lessor) who is licensed under IFTA and who is responsible to report
fuel usage and pay any tax due. Lessor's IFTA account number:
Effective date:
I will be applying for an IFTA license in another jurisdiction.
Please indicate the jurisdiction where you will register:
I choose to purchase fuel trip permits when traveling interstate (including return trips into California).
Other (please explain)
SECTION IV: Business Change (complete this section only if the information preprinted on the front of this application is incorrect
or if there has been a change in the ownership of the business)
1) NEW FEIN (Federal Employer Identification Number)
2) NEW DEPARTMENT OF TRANSPORTATION NUMBER (DOT)
3) TYPE OF NEW OWNERSHIP
Sole Proprietor
Other Partnership
Corporation/LLC
Married Co-Partnership
4) NEW CORPORATION/LLC NAME AND NUMBER (list names of corporate/LLC officers, members or managers below)
5) NEW OWNER/PARTNER/PRESIDENT NAME
SOCIAL SECURITY NUMBER
PHONE NUMBER
STREET ADDRESS (residence)
CITY
STATE
ZIP CODE
(
)
NEW PARTNER/VICE PRESIDENT NAME
SOCIAL SECURITY NUMBER
STREET ADDRESS (residence)
CITY
STATE
ZIP CODE
PHONE NUMBER
(
)
NEW PARTNER/TREASURER NAME
SOCIAL SECURITY NUMBER
STATE
ZIP CODE
PHONE NUMBER
STREET ADDRESS (residence)
CITY
(
)
NEW PARTNER/SECRETARY NAME
SOCIAL SECURITY NUMBER
STREET ADDRESS (residence)
CITY
STATE
ZIP CODE
PHONE NUMBER
(
)
6) NEW TRADE NAME/DBA
7) NEW LOCATION OF BUSINESS (do not use a PO Box or agent's address for location of business)
PHONE NUMBER
(
)
8) NEW MAILING ADDRESS (if different from business location; do not enter agent's address here)
PHONE NUMBER
(
)
10) NEW AGENT/BOOKKEEPER TELEPHONE NUMBER
9) NEW AGENT/BOOKKEEPER NAME
(
)
11) NEW AGENT/BOOKKEEPER MAILING ADDRESS
ACCOUNTANT CODE
Please use this address as my mailing address. (check box and attach signed power of attorney form to use agent address
for the account mailing address)
LOCATION
ACCOUNT NUMBER
12) NEW BANK OR OTHER FINANCIAL INSTITUTION
SECTION V: Signature (this section must be completed)
SIGNATURE
EMAIL ADDRESS
PRINT NAME AND TITLE
TELEPHONE
DATE
(
)
If you need additional information, please contact the State Board of Equalization, Motor Carrier Office, P.O. Box 942879,
Sacramento, CA 94279-0065. You may also visit the BOE website at or call the Taxpayer Information Section at
800-400-7115 (TTY:711); from the main menu, select the option Special Taxes and Fees.
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