Fillable INTERNATIONAL FUEL TAX AGREEMENT (IFTA) QUARTERLY TAX RETURN (Virginia Department of Motor Vehicles)

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INTERNATIONAL FUEL TAX AGREEMENT (IFTA) QUARTERLY TAX RETURN (Virginia Department of Motor Vehicles)

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The INTERNATIONAL FUEL TAX AGREEMENT (IFTA) QUARTERLY TAX RETURN (Virginia Department of Motor Vehicles) form is 2 pages long and contains:

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1. CARRIER NAME AND MAILING ADDRESS
3. VIRGINIAMCS NUMBER
4. IFTA ACCOUNT NUMBER
IMPORTANT NOTE: Refer to instructions (form RDT 121 I) before completing this return. Failure to correctly complete this return may subject
the carrier to penalty and interest. For assistance please contact DMV Motor Carrier Services at:
(804) 249-5130 (Voice) (800) 272-9268 (deaf or hearing impaired)
(804) 367-1073 (Fax) iftairp@dmv.virginia.gov (email)
INTERNATIONAL FUEL TAX AGREEMENT (IFTA)
QUARTERLY TAX RETURN
2. REPORTING PERIOD AND YEAR
5. FLEET IDENTIFIER
DUE DATE
RDT 121 (07/01/2020)
NOTICE OF CHANGE (CHECK THE FOLLOWING BOXES IF ANY APPLY TO THIS RETURN)
AMENDED RETURN (REFILE ALL INFORMATION, NOT JUST ADDITIONS)
CLOSE IFTA ACCOUNT/CANCEL LICENSE (I have destroyed all IFTA decals
and licenses)
NAME AND/OR ADDRESS CHANGE ENCLOSED
FUEL TYPE CODES:
Gasoline - G Gasohol - H Diesel - D Biodiesel - B Propane - P
Ethanol - E Methanol - M Compressed Natural Gas - C Electric - X
M85 - T Liquid Natural Gas - N Hydrogen - Y
E85 - F A55 - A Surtax - ST
SECTION 7. MILES PER GALLON CALCULATION
7A
FUEL TYPE
CODE
7B
ALL DISTANCE TRAVELED
(IFTA + NON-IFTA) (ROUNDED)
7C
TOTAL GALLONS PLACED IN ALL QUALIFIED VEHICLES
7D
AVERAGE MILES PER GALLON (MPG)
D
G
TOTALS
SECTION 8. FUEL TAX CALCULATION
8A 8B 8C 8D 8E 8F 8G 8H 8I 8J 8K
JURIS
ABBR.
FUEL TYPE
CODE
TOTAL DISTANCE
TAXABLE
DISTANCE
TAXABLE
GALLONS (8D
DIVIDED BY
7D)
GALLONS
PURCHASED
AND PLACED
IN VEHICLES
NET
TAXABLE
GALLONS
(8E MINUS 8F)
TAX
RATE
TAX DUE/
REFUND (8G
TIMES 8H)
INTEREST
DUE
TOTAL DUE/
REFUND
(8I PLUS 8J)
ROUND TO THE NEAREST WHOLE GALLON AND DISTANCE
VA D $ $ $
VA ST-D 0 $ $ $
VA G $ $ $
VA ST-G 0 $ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
(8M) SUBTOTALS
THIS PAGE
$ $ $
JURISDICTION
EXEMPTION
JURISDICTION
EXEMPTION
CHECK ONE (if applicable)
6A CHECK IF YOU DID NOT OPERATE TAX-QUALIFIED MOTOR VEHICLES THIS
QUARTER IN ANY IFTA JURISDICTION.
6B CHECK IF YOU OPERATED IN A JURISDICTION WHERE A TAXABLE MILEAGE
EXEMPTION APPLIES. (ENTER JURISDICTION & EXEMPTION)
5. FLEET IDENTIFIER
4. IFTA ACCOUNT NUMBER2. QUARTERLY REPORTING PERIOD AND YEAR1. CARRIER NAME
QUARTERLY TAX RETURN
RDT 121 (07/01/2020) -- Page 2
8. FUEL TAX CALCULATION - CHART B (MAKE ADDITIONAL COPIES OF THIS PAGE IF NEEDED)
8A 8B 8C 8D 8E 8F 8G 8H 8I 8J 8K
JURIS
ABBR.
FUEL TYPE
CODE
TOTAL DISTANCE
TAXABLE
DISTANCE
TAXABLE
GALLONS (8D
DIVIDED BY
7D)
GALLONS
PURCHASED
AND PLACED
IN VEHICLES
NET
TAXABLE
GALLONS
(8E MINUS 8F)
TAX
RATE
TAX DUE/
REFUND (8G
TIMES 8H)
INTEREST
DUE
TOTAL DUE/
REFUND
(8I PLUS 8J)
ROUND TO THE NEAREST WHOLE GALLON AND DISTANCE
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
(8L)NON-IFTA
D
NON-IFTA
DISTANCE
G
GALLONS
(8M) SUBTOTALS
THIS PAGE
$ $ $
(8N) SUBTOTALS
ALL ADDITIONAL PAGES
$ $ $
(8O) SUBTOTALS
FROM FRONT PAGE
$ $ $
MUST EQUAL 7B
SHOULD EQUAL 7C
(8P) TOTALS
$ $ $
MAIL RETURN
WITH PAYMENT
TO:
DEPARTMENT OF MOTOR VEHICLES
MOTOR CARRIER SERVICES
POST OFFICE BOX 27412
RICHMOND, VA 23269-0001
(8R) LATE FEE -- SEE
INSTRUCTIONS
(8S) GRAND TOTAL
DUE/REFUND
$
$
PAYMENT METHODS
ACH Debit authorized per signature below:
(check one)
CREDIT CARD / E-CHECK -- Provide contact name and number belowACH DEBIT -- Authorize by signing belowCHECK / MONEY ORDER -- Made payable to DMV
NOTE: In our continuing effort to safeguard customer information, DMV does not accept credit card payments by mail or email. You may pay with a credit card
by having a Motor Carrier Services Representative contact you. We accept checks and money orders via mail.
TELEPHONE NUMBER
DATE (mm/dd/yyyy)SIGNATURECONTACT NAME (print)
CERTIFICATION
PRINT NAME PRINT TITLE
I certify and affirm that all information presented in this return is true, correct and complete and that any documents I have presented to DMV
are genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation
under penalty of perjury and I understand that knowingly making a false statement or representation on this return is a criminal violation.
EMAIL ADDRESS
FAX NUMBER
( )
TELEPHONE NUMBER
DATE (mm/dd/yyyy)SIGNATURE
( )
( )
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INTERNATIONAL FUEL TAX AGREEMENT (IFTA) QUARTERLY TAX RETURN (Virginia Department of Motor Vehicles)

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Completed 29 July 2020

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