Michigan Department of Treasury 2873 (Rev. 03-11)
Temporary Michigan IFTA Permit
Issued under authority of Public Act 119 of 1980, as amended.
INSTRUCTIONS: Complete Parts 1, 2 and 3. Temporary permits are vehicle speciic. You must provide the vehicle identiication number (VIN) for each vehicle for which you are requesting a decal. You must write the application conirmation number in Part 3 if iled from www.michigan.gov/ifta or attach a copy of Form 3014 (Additional Decal) when faxing
or mailing this permit. If replacing a decal, Form 2824 (Application for Replacement Claiming Lost, Destroyed, Undelivered or Stolen State of Michigan IFTA Fuel Decal(s)) must be attached to this permit.
**IMPORTANT** Only current Michigan IFTA Licensees are eligible for this Temporary Permit Service. This permit is valid for thirty (30) days pending receipt of
permanent decals. This permit must be carried in the vehicle along with a copy of the current IFTA license. Any alterations or erasure renders this permit void. If you are requesting a permit for more than one vehicle, it is your responsibility to make copies of this permit and place it in the vehicles speciied below.
PART 1: APPLICANT INFORMATION
Michigan IFTA Account Number |
Current Year IFTA License Number |
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Name |
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Mailing Address |
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City |
State |
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ZIP Code |
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Telephone Number |
Fax Number |
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Authorized Signature |
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Title |
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PART 2: VEHICLE INFORMATION |
OFFICE USE ONLY |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Vehicle Information Number (VIN) |
Temporary Permit Number |
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Mail completed form to:
Special Taxes Division
Michigan Department of Treasury
P.O. Box 30474
Lansing, MI 48909
Forms can be faxed to (517) 636-4593. If you have questions, call (517) 636-4580.
PART 3: ONLINE CONFIRMATION NUMBER
Additional Decal Request Conirmation Number