Form 74 026 001 01 PDF Details

Navigating the complexities of tax obligations for motor carriers operating across state lines becomes significantly more manageable with the International Fuel Tax Agreement (IFTA). The Mississippi Registration Application for IFTA Credentials, officially known as Form 74-026-001-01, plays a crucial role in this process, providing a streamlined approach for businesses to comply with fuel tax reporting and payment requirements. This form, revised in February 2001, requires detailed information from applicants, including their Federal Identification Number or Social Security Number for sole proprietors, the legal name of the business, and contact details. Apart from basic identification and business information, the application delves into the specifics such as types of ownership, a listing of officers or partners in certain business models, and whether the business has previously held IFTA credentials. Applicants must also detail the operational scope of their vehicles, including whether they are leased, types of fuel used, and the jurisdictions in which they operate or have bulk fuel storage. By accurately completing and submitting this form, motor carriers in Mississippi can obtain the necessary IFTA decals and credentials, ensuring compliance with multi-state fuel tax reporting requirements while potentially streamlining their operational logistics and financial obligations related to fuel usage across different states and provinces.

QuestionAnswer
Form NameForm 74 026 001 01
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesIRP, Indiana, LLP, MISSISSIPPI

Form Preview Example

Form 74-026-001-01 Rev 02/2001

MISSISSIPPI

Registration Application for International Fuel

Tax Agreement (IFTA) Credentials

1.Enter your Federal I. D. Number if a corporation or partnership or Social Security Number if sole owner.

Federal I D No. ___ ___ - ___ ___ ___ ___ ___ ___ ___ Social Security No. ___ ___ ___- ___ ___ - ___ ___ ___ ___

2.Legal Name Of Applicant Business Name (DBA)

3.Street Address:

 

City

 

 

 

 

State

Zip Code

 

County

 

 

 

4.

Contact Person

 

 

 

 

 

 

Telephone Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fax Number:

 

 

 

Internet E-mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

State

Zip Code

 

 

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Type of Ownership:

 

 

Corporation

 

 

 

Partnership - General

 

 

Sole Ownership

 

 

 

 

 

 

 

 

 

 

 

S Corporation

 

 

 

Partnership - Limited

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LLC

 

 

LLP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

If C Corp., S Corp, LLC, LLP,

or Partnership, list the names of the officers or partners.

 

 

 

 

 

 

 

 

 

 

Name

 

Address

 

 

 

Title

Social Security No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. Corporation organized under Laws of State of

9. Date admitted or authorized to do business in Mississippi

 

 

Date began business

 

 

 

 

 

 

 

 

 

 

10. Have you previously held International Fuel Tax Agreement (IFTA) Credentials?

 

 

 

 

 

 

Yes

No

.

 

 

 

 

 

 

 

 

 

If yes, please indicate the Account No.

and the base jurisdiction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.Complete the following if your vehicles are leased to another motor carrier. Name and address of lessor

Lessor's Phone

12. Who is responsible for reporting Interstate Motor Carrier Fuel Taxes: Lessor Lessee

13. If a Reporting Service completes your fuel tax report, give its Name, Address, and Phone Number.

14. Do you want your Tax Report mailed to the Reporting Service?

 

Yes

 

No

15.If a Reporting Service completes your fuel tax report, please execute a Power of Attorney.

APPLICATION

FOR INTERNATIONAL FUEL TAX AGREEMENT (IFTA)

 

CREDENTIALS

 

 

 

 

16. IRP (Apportioned Tag) Account No.

 

 

IRP Base State

 

 

Do you have vehicles based for IRP in states other than Mississippi? No (

) Yes ( ) If yes, which state(s).

 

 

Do you have a farm tag issued by the State of Mississippi ?

Yes

No. If yes, indicate the farm tag No.

17.U. S. DOT Number

18.Indicate fuel type:

Check applicable carrier type.

Diesel Fuel

 

Gasoline

 

Gasohol

 

Common

 

Contract

 

 

 

 

Compressed Gas Natural Gas

Private

19.Complete the schedule below by placing an "X" next to the jurisdictions in which you operate Qualified Motor Vehicles and /or have bulk storage of fuel.

__

__

AK

Alaska

__

__

Ml

Michigan

__

__

TX

Texas

__

__

AL

Alabama

__

__

MN

Minnesota

__

__

UT

Utah

__

__

AR

Arkansas

__

__

MO

Missouri

__

__

VA

Virginia

__

__

AZ

Arizona

__

__

MS

Mississippi

__

__

VT

Vermont

__

__

CA

California

__

__

MT

Montana

__

__

WA

Washington

__

__

CO

Colorado

__

__

NC

North Carolina

__

__

WI

Wisconsin

__

__

CT

Connecticut

__

__

ND

North Dakota

__

__

WV

West Virginia

__

__

DC

Dist. Columbia

__

__

NE

Nebraska

__

__

WY

Wyoming

__

__

DE

Delaware

__

__

NH

New Hampshire

__

__

AB

Alberta

__

__

FL

Florida

__

__

NJ

New Jersey

__

__

BC

British Columbia

__

__

GA

Georgia

__

__

NM

New Mexico

__

__

LB

Labrador

__

__

IA

Iowa

__

__

NV

Nevada

__

__

MB

Manitoba

__

__

ID

Idaho

__

__

NY

New York

__

__

NB

New Brunswick

__

__

IL

Illinois

__

__

OH

Ohio

__

__

NF

Newfoundland

__

__

IN

Indiana

__

__

OK

Oklahoma

__

__

NS

Nova Scotia

__

__

KS

Kansas

__

__

OR

Oregon

__

__

NT

N W Territory

__

__

KY

Kentucky

__

__

PA

Pennsylvania

__

__

ON

Ontario

__

__

LA

Louisiana

__

__

RI

Rhode Island

__

__

PE

Prince Edward Island

__

__

MA

Massachusetts

__

__

SC

South Carolina

__

__

PQ

Quebec

__

__

MD

Maryland

__

__

SD

South Dakota

__

__

SK

Saskatchewan

__

__

ME

Maine

__

__

TN

Tennessee

__

__

YT

Yukon Territory

REQUEST FOR INTERNATIONAL FUEL TAX AGREEMENT DECALS

20. Number of Motor Vehicles requiring IFTA decals.

Additional Decals may be requested by letter stating the number required. Attach a copy of your IFTA License to such letter.

Under the penalties of perjury, the applicant declares the information given is, to the best of his knowledge, true, accurate and complete. The applicant agrees to comply with the reporting, record keeping, and license display requirements of the International Fuel Tax Agreement and/or of the Laws of the State of Mississippi. The applicant further agrees that base jurisdiction may withhold any refunds due if applicant is delinquent on 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.

Signature

Title

Date

Mail the completed application & attachments to:

Mississippi State Tax Commission

 

 

P.O. Box 1140

 

Telephone: 601-923-7150 Fax 601-923-7165

Jackson, MS 39215-1140