Transcription of IFTA Quarterly Fuel Tax Report (IFTA-100) - PaTruckTags.com
1 IFTA-100 MFAFP(04-09)BUREAUOFMOTORFUELTAXESPOBOX2 80646 HARRISBURGPA17128-0646 IFTAQ uarterlyFuelTaxReportII1 IIAccountNumberpennsyLvaniaDEPARTMENTOFR EVENUEII1 IIPeriodCQuarter&Year)_TaxPeriodEndDate_ ACTIVITYBOXII1 IICheckAppropriateBlock[]NoActivityThisQ uarter[]CancelLicense-FinalReport[]Chang eName,AddressorEIN[] :UsethisreporttosummarizeQuarterlyFuelTa xScheduleCs)undertheInternationalFuelTax AgreementCIFTA) :PADepartmentofRevenuePOBOX280410 EntertheamountofHarrisburgPA17128-0410yo urremittancehere--->$Makean"X"intheappro priatebox:paymentremittedviaEFTDII1 IIcertifiedcheckDII1 IIAttachaformIFTA-101(IFTAQ uarterlyFuelTaxSchedule) $ ) ) ,2,3,4&5.
2 ,I11 III6$ )I11 III8$ $ )I11 III10$ $ $ ) ,correctandcompletePRINTNAMESIGNATURETEL EPHONENUMBERTITLEIDATEAREACODE()96100091 00