Transcription of International Fuel Tax Agreement (IFTA) Application
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International Fuel Tax Agreement (IFTA) Application
R-5678-L (2/02). State of Louisiana Department of Revenue International Fuel Tax Agreement (IFTA) Application Telephone (225) 219-7656. TDD (225) 219-2114. Application Fee: $ Make address Account number changes in area provided on back and mark here. Legal name Trade name Address City, state, ZIP. ( ). Contact person _____ Telephone _____. ( ). Date of Application _____ Telefax _____. Type of ownership: Individual Partnership Corporation Other Federal ID No. SS No. SIC No. List Interstate Commerce Commission Motor Carrier (ICC) Number _____. List International Registration Plan (IRP) Number _____. All corporations must provide the following information: State of incorporation _____ Date of incorporation _____. State of commercial domicile _____ Fiscal year ending date _____. If not incorporated in Louisiana, indicate date authorized to do business in Louisiana _____.
OR Oregon PA Pennsylvania ... Excise Section Excise Section P.O. Box 201 617 North Third Street Baton Rouge, LA 70821-0201 Baton Rouge, LA 70802 ... R-5678-L (2/02) International Fuel Tax Agreement (IFTA) Application ( ) Title: 5678-L (2/02) Author: charles cryer Created Date:
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