IFTA Fuel Tax Report Form
Report mileage and fuel usage for the International Fuel Tax Agreement. Please complete all applicable fields accurately.
Carrier/Business Name
*
Reporting Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reporting Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Base Jurisdiction
*
USDOT Number
*
Vehicle/Unit Number
*
License Plate Number
*
Vehicle Identification Number (VIN)
*
Total Miles Traveled (All Jurisdictions)
*
Taxable Miles by Jurisdiction
Rows
Jurisdiction
Taxable Miles
Row 1
Row 2
Row 3
Total Fuel Purchased (Gallons)
*
Taxable Gallons by Jurisdiction
Rows
Jurisdiction
Taxable Gallons
Row 1
Row 2
Row 3
Notes / Remarks
Submit Report
Should be Empty: