Michigan Department of Treasury
4460 (Rev. 10-19)
IFT LIC
IFTA Request for Cancellation of Account
ACCOUNT INFORMATION
Company/Individual Name Taxpayer ID (FEIN or TR Number) IPC Account Number
Address City, State, ZIP Code
Contact Person Name Telephone Number
ACTION REQUEST
If your cancellation request has been approved, you must destroy all decals and licenses for the account. MCL 207.215(7) provides: “If a licensee
ceases to engage in business within this state, the licensee shall notify the department in writing within 15 days after discontinuance.”
I wish to cancel my IFTA account eective _____________________ for the following reason(s):
I am leased with a company that provides IFTA licensing and tax reporting. Attach complete lease agreement.
Company Name I am Leased to Lease Start Date
Address City, State, ZIP Code
Jurisdiction of Decals Supplied by Lease Company Decal Number(s) (attach additional sheets if necessary)
I am no longer in the trucking business.
I am incorporated and ling under a new account number. My new IFTA account number is _________________________________________
Other (explain) _____________________________________________________________________________________________________
CERTIFICATION
I have destroyed all IFTA decals and license(s) for this account. I certify under penalty of perjury that the information supplied here is true and complete to
the best of my knowledge. I understand that if any of the statements in this application are false or misleading, the Department of Treasury may demand
immediate reimbursement for any funds spent based on my statements. I further understand that if any false or misleading statements were made with
intent to defraud the State of Michigan, the Department of Treasury may request prosecution to the full extent of the law.
I agree I am liable for the ling of all tax returns due based upon the Department’s eective cancellation date.
Printed Name
Signature Date
Mail this form to:
Michigan Department of Treasury
Special Taxes Division - IFTA
P.O. Box 30474
Lansing, MI 48909
Any questions? Call 517-636-4580 or Fax 517-636-4593.
Deaf, hearing or speech impaired persons should call 517-636-4999 (TDD).
