Get NC GAS-1274A 2021-2023

GAS-1274A Web 3-14 Renewal Application for License and Decals North Carolina Department of Revenue DOR Use Only Legal Name First 35 Characters USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS FEIN or SSN Mailing Address NCDOR ID/State Number City State Zip Code Fill in circle if applicable Name of Contact Person Phone Number Address has changed Close IFTA account effective MM-DD-YYYY Fax Number Close Intrastate account effective MM-DD-YYYY Email Address 1. Signature Title Date MAIL TO North Carolina Department of Revenue Excise Tax Division Post Office Box 25000 Raleigh North Carolina 27640-0950 QUESTIONS Contact the Excise Tax Division at Telephone Number 919 707-7500 Toll-free Number 877 308-9092 Fax Number 919 733-8654 Gas-1274A REQUIREMENTS FOR RENEWAL OF DECALS allows carriers to receive one set of decalsfor each qualified motor vehicle from their base jurisdiction and file one quarterly fuel tax report for all IFTA jurisdictions. a* Do you have license plates issued by the North Carolina Division of Motor Vehicles on one or more of your qualified motor vehicles 1a* b. If yes list the license tag of at least one qualified motor vehicle. 1b. 2. Do your qualified motor vehicles travel ONLY in North Carolina 3. Number of sets of IFTA Interstate decals requested 1 set 2 decals Yes No NOTE One decal set will be issued for each qualified vehicle. Order only one decal set for each qualified vehicle. General Information One license will be issued per licensee. A photocopy of the license must be carried in each qualified motor vehicle. The original license should be kept in a safe place. Additional decals may be requested using this form* Applicant agrees to comply with tax reporting payment recordkeeping and license display requirements as specified in the International Fuel Tax Agreement and by North Carolina General Statutes and Administrative Procedures Act Rules. The applicant further agrees that the North Carolina Department of Revenue may withhold any refunds due if applicant is delinquent on payment to any other division within the North Carolina Department of Revenue or delinquent taxes due to any IFTA member jurisdiction* Failure to comply with these provisions shall be grounds for revocation of license in all member jurisdictions. The applicant further certifies with his or her signature or electronic submission as deemed acceptable by North Carolina that to the best of his or her knowledge the information is true accurate and complete and any falsification subjects the applicant to appropriate North Carolina civil and/or criminal sanctions. Also by signing below the applicant acknowledges that certain taxpayer information supplied to the North Carolina Department of Revenue will be transmitted electronically to IFTA Inc* including but not limited to certain transmittal and demographic data required under the IFTA agreement for purposes of administering the IFTA program and consents to the same. Currently the IFTA membership consists of 48 states and 10 Canadian provinces. International Fuel Tax Agreement IFTA Decals Decals are required for Qualified Motor Vehicles.