Form 2873 - Temporary Michigan Ifta Permit

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Michigan Department of Treasury
2873 (Rev. 03-11)
Temporary Michigan IFTA Permit
Issued under authority of Public Act 119 of 1980, as amended.
INSTRUCTIONS: Complete Parts 1, 2 and 3. Temporary permits are vehicle specific. You must provide the vehicle identification number (VIN) for each vehicle for which you are
requesting a decal. You must write the application confirmation number in Part 3 if filed from or attach a copy of Form 3014 (Additional Decal) when faxing
or mailing this permit. If replacing a decal, Form 2824 (Application for Replacement Claiming Lost, Destroyed, Undelivered or Stolen State of Michigan IFTA Fuel Decal(s)) must be
attached to this permit.
**IMPORTANT** Only current Michigan IFTA Licensees are eligible for this Temporary Permit Service. This permit is valid for thirty (30) days pending receipt of
permanent decals. This permit must be carried in the vehicle along with a copy of the current IFTA license. Any alterations or erasure renders this permit void. If you
are requesting a permit for more than one vehicle, it is your responsibility to make copies of this permit and place it in the vehicles specified below.
PART 1: APPLICANT INFORMATION
PART 2: VEHICLE INFORMATION
OFFICE USE ONLY
Michigan IFTA Account Number
Current Year IFTA License Number
Vehicle Information Number (VIN)
Temporary Permit Number
Name
Vehicle Information Number (VIN)
Temporary Permit Number
Vehicle Information Number (VIN)
Temporary Permit Number
Mailing Address
Vehicle Information Number (VIN)
Temporary Permit Number
Vehicle Information Number (VIN)
Temporary Permit Number
City
State
ZIP Code
Telephone Number
Fax Number
Vehicle Information Number (VIN)
Temporary Permit Number
Vehicle Information Number (VIN)
Temporary Permit Number
Authorized Signature
Title
Mail completed form to:
PART 3: ONLINE CONFIRMATION NUMBER
Special Taxes Division
Additional Decal Request Confirmation Number
Michigan Department of Treasury
P.O. Box 30474
Lansing, MI 48909
Forms can be faxed to (517) 636-4593. If you have questions, call (517) 636-4580.
OFFICE USE ONLY
Expiration Date
Certification Approved by
Date Issued
Beginning Date

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