Transcription of IFTA License and Decals Application - Minnesota
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PS2261-21 12/2020 IFTA License and Decals Application Registration YearNew / Renewal License ExemptionExtra Decals change Account InformationCancel Account (Attach License and Decals ) or check box if destroyed, lost or mutilated Account NamePhysical address of BusinessBusiness Mailing AddressAccount NumberFEINUSDOT # Contact Phone Number Exemptions If you qualify for one of the following exemptions, check the appropriate box and sign this Application . Company holds a current IFTA License in a jurisdiction other than # Leased to carrier that reports fuel tax. Carrier NameJurisdictionAccount # Operating only two-axle vehicles with gross vehicle weight of 26,000 pounds or less. If you do not qualify for an exemption, complete items 1 through 4 and sign this Application . 1. Print names and titles of: Owner(s) Partner(s) Corporate officer(s)NameTitleNameTitleMINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICES 2.
IFTA License and Decals Application . Registration Year New / Renewal License . Exemption. Extra Decals Change Account Information Cancel Account (Attach license and decals) or check box if destroyed, lost or mutilated . Account Name Physical Address of Business Business Mailing Address Account Number FEIN USDOT # Contact Phone Number . Exemptions
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