Form Dr 0125 - Colorado Renewal Application For International Fuel Tax Agreement License

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DR 0125 (01/03/13)
COLORADO DEPARTMENT OF REVENUE
Excise Tax Accounting Section - Room 200
Denver CO 80261
Renewal Application for
International Fuel Tax
Agreement License
Colorado Account Number
IFTA Account No. (FEIN or SSN)
Period
Due Date
Check here for change of name, address or email
Name
Address
Email
Each IFTA vehicle requires two decals.
Enter the number of decals needed here: __________________________________________________________________
Enter number of decals issued by Service Center: ___________________________________________________________
“X” The Jurisdictions In Which You Travel
AL - Alabama
KS - Kansas
NM - New Mexico
VA - Virginia
AK - Alaska
KY - Kentucky
NY - New York
WA - Washington
AZ - Arizona
LA - Louisiana
NC - North Carolina
WV - West Virginia
AR - Arkansas
ME - Maine
ND - North Dakota
WI - Wisconsin
CA - California
MD - Maryland
OH - Ohio
WY - Wyoming
CO - Colorado
MA - Massachusetts
OK - Oklahoma
Canadian Jurisdictions
CT - Connecticut
MI
- Michigan
OR - Oregon
AB - Alberta
DE - Delaware
MN - Minnesota
PA - Pennsylvania
QC - Quebec
DC - Dist of Col.
MS - Mississippi
RI
- Rhode Island
BC - British Columbia
FL
- Florida
MO - Missouri
SC - South Carolina
MB - Manitoba
GA - Georgia
MT - Montana
SD - South Dakota
ON - Ontario
ID
- Idaho
NE - Nebraska
TN - Tennessee
NB - New Brunswick
IL
- Illinois
NV - Nevada
TX - Texas
NF - Newfoundland
IN
- Indiana
NH - New Hampshire
UT - Utah
NS - Nova Scotia
IA
- Iowa
NJ - New Jersey
VT - Vermont
PE - Prince Edward Island
SK - Saskatchewan
Type of Fuel Used
Indicate the IFTA member states in which you maintain bulk fuel storage
1. DIESEL
5. LNG
9. E-85
2. LPG
6. CNG
10. M-85
3. GASOLINE
7. ETHANOL
11. A55
4. GASOHOL
8. METHANOL
The applicant agrees to comply with reporting, payment, record keeping and license display requirements as specified in the International Fuel Tax
Agreement. The applicant further agrees that Colorado may withhold any refunds due if applicant is delinquent in payment of fuel taxes due any member
jurisdiction. Failure to comply with these provisions shall be grounds for revocation of license in all member jurisdictions.
I certify under penalty of perjury in the second degree that to the best of my knowledge the above information is true and correct.
Signature (owner, partner, or authorized representative)
Date
Title
Telephone

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