Form Ifta-1 - International Fuel Tax Agreement (Ifta) License Application Page 2
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1
2Indicate type of fuel used (Check all that apply)
Diesel
Gasoline
Propane
Natural gas
Ethanol/Gasohol
Indicate with an "X" the jurisdictions in which you are operating and also those in which you maintain bulk fuel
storage locations. (OP=Operate; BK=Bulk Fuel).
Jurisdiction
Jurisdiction
Jurisdiction
Jurisdiction
OP
BK
OP BK
OP BK
OP BK
AL
LA
OH
CANADIAN PROVINCES
Alabama
Louisiana
Ohio
AK
ME
OK
AB
Alaska
Maine
Oklahoma
Alberta
AZ
MD
OR
BC
Arizona
Maryland
Oregon
British Columbia
AR
MA
PA
MB
Arkansas
Massachusetts
Pennsylvania
Manitoba
CA
MI
RI
NB
California
Michigan
Rhode Island
New Brunswick
CO
MN
SC
NF
Colorado
Minnesota
South Carolina
New Foundland
CT
MS
SD
NW
Connecticut
Mississippi
South Dakota
Northwest Territory
DE
MO
TN
NS
Delaware
Missouri
Tennessee
Nova Scotia
DC
MT
TX
ON
Dist. Columbia
Montana
Texas
Ontario
FL
NE
VA
PE
Florida
Nebraska
Virginia
Prince Edward Island
GA
NV
WA
QC
Georgia
Nevada
Washington
Quebec
ID
NH
WV
SK
Idaho
New Hampshire
West Virginia
Saskatchewan
IL
NJ
WI
YU
Illinois
New Jersey
Wisconsin
Yukon Territory
IN
NM
WY
Indiana
New Mexico
Wyoming
IA
NY
UT
Iowa
New York
Utah
KS
NC
VT
Kansas
North Carolina
Vermont
KY
ND
Kentucky
North Dakota
Sign this application
CERTIFICATION-
The applicant agrees to comply with reporting, payment, recordkeeping, and display requirements as specified
in the International Fuel Tax Agreement. The applicant authorizes the State of Rhode Island to withhold any
refund of fuel use tax overpayment, if delinquent taxes are due any member IFTA jurisdiction.
Failure to comply with these provisions shall be grounds for revocation of the IFTA license in all member
jurisdictions. The applicant agrees under penalty of perjury, that the information is, to the best of his/her
true, accurate, and complete.
A copy of the IFTA Information and Compliance Manual can be found at the Tax Division's website at
Type or print authorized signature
Title
Applicant Signature
Date
Return to: Rhode Island Division of Taxation
Excise Tax Section
One Capitol Hill
Providence, RI 02908-5800
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