Form 2824 - Application For Replacement Claiming Lost, Destroyed, Undelivered Or Stolen State Of Michigan Ifta Fuel Decal(S)

Download a blank fillable Form 2824 - Application For Replacement Claiming Lost, Destroyed, Undelivered Or Stolen State Of Michigan Ifta Fuel Decal(S) in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 2824 - Application For Replacement Claiming Lost, Destroyed, Undelivered Or Stolen State Of Michigan Ifta Fuel Decal(S) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Reset Form
Michigan Department of Treasury
Clerk's Initials
2824 (Rev. 7-09)
Application for Replacement Claiming Lost, Destroyed,
Date
Undelivered or Stolen State of Michigan IFTA Fuel Decal(s)
Issued under P.A. 119 of 1980. Filing is voluntary.
INSTRUCTIONS: Use this form to request a replacement for any lost, destroyed, stolen or undelivered IFTA Decals. Also use this form to request a
replacement for decals from a licensed vehicle which is sold. The decal should be torn from the sold vehicle and destroyed. The buyer of the vehicle
must be identified in number 11 below. Please print or type.
1. Complete Company Name (include Corp., Inc., P.C., L.L.C., etc.)
2. Account Number (FEIN, ME, TR, IFTA)
3. Business Name, Assumed Name or DBA (if used)
4. IRP Number
5. Address (Number and Street or RR#, City, State, Zip)
6. Decal Year
7. Quantity of Decals
8. Phone Number
9. Enter below the serial number(s) of the fuel decal(s) that are being replaced. (Required if decal lost, destroyed, stolen or vehicle disposed of or sold)
I certify the following:
10.
that I am the licensee or authorized representative of the licensee named above and that the decals listed above have been:
lost
destroyed
undelivered
stolen
OR
that I have sold or disposed of and replaced a licensed vehicle and have removed and destroyed its decal. The vehicle I
11.
sold or disposed of is now owned by (name, address, city, state, ZIP):
Based on the above statements, I request that the Department of Treasury issue replacement decals.
I agree that if the above decals are found I will return them promptly to the Department of Treasury to be voided.
I certify under penalty of perjury that the information supplied here is true and complete to the best of my knowledge. I
understand that if any of the statements in this application are false or misleading, the Department of Treasury may demand
immediate reimbursement for any funds spent based on my statements. I further understand that if any false or misleading
statements were made with intent to defraud the State of Michigan, the Department of Treasury may request prosecution to the
full extent of the law.
Licensee or authorized representiatve signature (in ink)
Date
Mail your application to:
Michigan Department of Treasury
Special Taxes Division
P.O. Box 30474
Lansing, MI 48909-7974
Any questions? Call (517) 636-4580 or FAX (517) 636-4593.
Deaf, hearing or speech impaired persons should call (517) 636-4999 (TDD)
Do Not Write Below This Line
Enter at right the serial
numbers of
replacement decals
issued.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go