Form Sf-801 - Alternative Fuel Decal Application
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1
2
3Indiana Department of Revenue
SF-801
Alternative Fuel Decal
State Form 46292
(R4 / 9-12)
Application
Name (as shown on vehicle registration)
Federal Identifi cation or Social Security Number (must be provided)
Address
City
State
Zip Code
Annual Motor Carrier or IFTA Permit Number (if applicable) ______________________
Date of
Is Vehicle
Current
Purchase,
Capable of
Registered
Vehicle
Tax Rate
Registered Vehicle
Odometer
Conversion, or
Using Gas?
Gross
Category
from Rate
Identifi cation Number
Year Make Model
Reading
Registration
Yes/No
Weight
Number
Schedule
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Total Decals Ordered
For Department Use Only
Tax Due ......................................
Category #
From
To
For Department Use Only
Check
Check
Amount:
Number:
Keep copies of this application form in each
vehicle until you receive your decals!
Under the penalty of perjury, I have examined this return (including accompanying schedules and statements) and, to the best of my
knowledge and belief, it is true, complete, and correct.
Taxpayer or Authorized Agent
Type or Print Name
Title
Date Signed
Telephone Number
□
Please Check Box If Last Filing
Date Business Closed ___________/__________/_____________
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Parent category: Financial