Free boe400d - California

BOE-400-D REV. 3 (2-05)

STATE OF CALIFORNIA

BOARD OF EQUALIZATION

REQUEST FOR ADDITIONAL IFTA DECALS
FOR YEAR [FOID]
Mail To:
YOUR ACCOUNT NO.

BOARD USE ONLY
RA-B/A RR-QS EFF AUD FILE REG REF

STATE BOARD OF EQUALIZATION FUEL TAXES DIVISION PO BOX 942879 SACRAMENTO CA 94279-6180

NAME

BUSINESS ADDRESS

CITY

STATE

ZIP CODE

READ INSTRUCTIONS BEFORE PREPARING

IFTA ACCOUNT NUMBER

You may use this form to order decals for qualified motor vehicles that you wish to add to your IFTA fleet. You must have a current IFTA license issued by the California State Board of Equalization and your account must be in good standing. SECTION I: Decal and Fee Computation (this section must be completed)

1. Enter the number of qualified vehicles requiring decals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Fee per set of decals
... .................................................................................

2. $ 2.00 3. $

3. Total decal fee enclosed (multiply line 1 by line 2)

.......................................................

SECTION II: Vehicle Information (List complete information for each qualified motor vehicle that you wish to add to your IFTA fleet;
attach a separate sheet if needed.)
MAKE AND YEAR BASE STATE VEHICLE REGISTRATION VIN/LICENSE NUMBER TYPE OF FUEL USED REGISTERED OWNER IF DIFFERENT THAN IFTA ACCOUNT

Make check or money order payable to the State Board of Equalization. Remittance must be in U.S. funds. Always write your account number on your check or money order. Make a copy of this document for your records.
YOUR SIGNATURE AND TITLE TELEPHONE NUMBER DATE

(

)

IF YOU WISH ADDITIONAL INFORMATION, PLEASE CONTACT THE STATE BOARD OF EQUALIZATION, FUEL TAXES DIVISION, PO BOX 942879, SACRAMENTO, CA 94279-0065, TELEPHONE 916-322-9669

CLEAR

PRINT