Form Mv Ifta-1 - Application For License International Fuel Tax Agreement - Alabama Department Of Revenue Page 2
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2Indicate with an “X” the jurisdictions in which you are operating and those in which you maintain bulk fuel storage.
(OP = Operate, BF = Bulk Fuel)
OP
BF
JURISDICTION
OP
BF
JURISDICTION
OP
BF
JURISDICTION
OP
BF
JURISDICTION
AL Alabama
KY Kentucky
NC N. Carolina
WI Wisconsin
AK Alaska
LA Louisiana
ND N. Dakota
WY Wyoming
CANADIAN PROVINCES
AZ Arizona
ME Maine
OH Ohio
AR Arkansas
MD Maryland
OK Oklahoma
AB Alberta
CA California
MA Massachusetts
OR Oregon
BC Br. Columbia
CO Colorado
MI Michigan
PA Pennsylvania
MB Manitoba
CT Connecticut
MN Minnesota
RI Rhode Island
NB New Brunswick
DE Delaware
MS Mississippi
SC S. Carolina
NF Newfoundland
DC Dist. of Col.
MO Missouri
SD S. Dakota
NS Nova Scotia
FL Florida
MT Montana
TN Tennessee
ON Ontario
GA Georgia
NE Nebraska
TX Texas
PE Prince Edward Is.
ID Idaho
NV Nevada
UT Utah
QC Quebec
IL
Illinois
NH New Hampshire
VT Vermont
SK Saskatchewan
IN Indiana
NJ New Jersey
VA Virginia
IA
Iowa
NM New Mexico
WA Washington
KS Kansas
NY New York
WV West Virginia
Under penalties of perjury, the applicant declares the information given is, to the best of his/her knowledge, true, accurate, and complete.
The applicant agrees to comply with the reporting, payment, record keeping, and license requirements of the International Fuel Tax
Agreement and/or the laws of the State of Alabama. The applicant agrees that any falsification subjects him or her to appropriate civil
and/or criminal sanctions of the base jurisdiction. The applicant further agrees that the Alabama Department of Revenue may withhold
any refunds due if applicant is delinquent on payment of fuel taxes due any member jurisdictions. Failure to comply with these provi-
sions shall be grounds for revocation of the IFTA license in all member jurisdictions. This application must be signed by all partners, one
corporate officer, or a member listed in the ownership information section. If the business is a sole proprietorship, the owner must sign
the application. An attorney or agent of the taxpayer may sign the application if authorized by a power of attorney. If additional signa-
tures are required, please provide an attachment to this form. Incomplete applications will be returned to the applicant.
________________________________________
________________________________
____________________
SIGNATURE
TITLE
DATE
________________________________________
________________________________
____________________
SIGNATURE
TITLE
DATE
Submit form via email at mcs@revenue.alabama.gov or by fax at (334) 242-9073. If by mail, attach check (personal or company) or
money order payable to Alabama Department of Revenue.
Mail Application To:
Alabama Department of Revenue
Motor Vehicle Division
Motor Carrier Services
P.O. Box 327620
Montgomery, AL 36132-7620
Telephone:
(334) 242-9000
Web Site:
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