Indiana Department of Revenue Application for Repair and Maintenance Permit MF-660C State Form 49097 (R/4-04) Company Name: FEIN or SSN: DBA Name: Telephone Number: Address: City: State: Zip Code: Place an X in the appropriate box for the repair/maintenance permit you are applying for: International Fuel Tax (IFTA) Repair/Maintenance Permit ($40.00) International Registration Plan (IRP) Repair/Maintenance Permit ($40.00) Both - IFTA and IRP ($80.00) Purchasing the International Fuel Tax Repair/Maintenance permit exempts the owner of the repair and maintenance permit from reporting and paying Indiana quarterly fuel taxes while traveling in Indiana to have the vehicles, semi-trailers, or trailers repaired. Purchasing the International Registration Plan Repair/Maintenance permit exempts the owner of the repair and maintenance permit from reporting and paying Interstate registration fees while traveling in Indiana to have the vehicles, semi-trailers, or trailers repaired. The cost for either the IFTA or IRP Repair/Maintenance permit is $40.00. The cost for both permits is $80.00. This application for repair and maintenance permit applies to all vehicles, semi-trailers, or trailers operated by the named carrier. This application is not transferable to another carrier. Under penalty of perjury, I declare that I have examined this Repair/Maintenance Permit Application and to the best of my knowledge and belief it is true, correct, and complete. I further declare that I will distribute the repair and maintenance permit issued to me by the Indiana Department of Revenue only to the vehicles, semi-trailers, or trailers I am operating or causing to be operated. Signature: Date: Title: Please mail completed form to: IRP Unit Attn: Rena Hobein 5252 Decatur Boulevard, Suite R Indianapolis, IN 46241 or Fax to: (317) 821-2335 American LegalNet, Inc. www.FormsWorkflow.com