South Dakota Combined Irp/ifta Application
ADVERTISEMENT
1
2South Dakota Combined IRP/IFTA Application
445 East Capitol Avenue, Pierre, SD 57501-3185
605-773-3314 – IRP
605-773-5408 - IFTA
Application for:
IRP (International Registration Plan)
Effective Date:
Do you hold Wyoming Intra-State Authority?
Expiration Month (Select One)
Yes
No (Please mark one)
Feb
May
Aug
Nov
IFTA (International Fuel Tax Agreement) Effective Date:
FOR OFFICE USE ONLY
IRP/IFTA Account #
Have you previously been registered in South Dakota or any other jurisdiction?
Yes
No
If yes, check all that apply:
IRP
IFTA
Jurisdiction:
If not South Dakota, explain why you were licensed in another jurisdiction (Must report actual miles if within 18 months)
If previously leased on with a company or individual, specify company name, address and reason for leaving (Must report actual miles if within 18
months)
Were you or any other affiliated company ever revoked?
Yes
No
If yes, name of company:
Company Information
Employer Identification Number:
Social Security Number:
LEGAL NAME:
D/B/A (Doing Business As) if different from legal name:
Sole Proprietor
Partnership
Corporation
Limited Liability Company
Other:
State of Incorporation:
Date of Incorporation:
If not incorporated in South Dakota, indicate date of registration with the South Dakota Secretary of State:
Are you leasing to a Motor Carrier?
NO
YES If YES with whom?
PHYSICAL ADDRESS:
Street
City
State
Zip Code
MAILING ADDRESS:
Street
City
State
Zip Code
Phone Number:
Cell Number:
Fax Number:
Contact Name:
Phone Number:
E-Mail Address:
Owners, Partner or Corporate Officers
(one of the listed individuals must sign as Applicant). Addresses must be home address,
not business address. As provided in Section 7(b) of the Federal Privacy Act of 1974, you are informed that the Social Security number
is a mandatory request and requirement pursuant to 10-47B.
Title:
Name:
Social Security Number:
Address
Phone Number:
Title:
Name:
Social Security Number:
Address
Phone Number:
Title:
Name:
Social Security Number:
Address
Phone Number:
Title:
Name:
Social Security Number:
Address
Phone Number:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial