Cancellation Of License Form
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Cancellation Of License Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Cancellation Of License Form, MCT-627, Indiana Statewide, Department Of Revenue
INDIANA REVENUE FORM
INDIANA DEPARTMENT OF REVENUE
MOTOR CARRIER SERVICES DIVISION
MCT-627
Rev. 01/99
CANCELLATION OF LICENSE FORM
Company Name:
DBA Name:
Address:
City:
State:
Zip Code
Please provide all license numbers to which the above cancellation applies:
1.
TID:
2.
IFTA License Number: IN-
3.
Motor Carrier Fuel Tax Permit Number: IN-
4.
Other:
Signature:
Typed or Printed Name:
Title:
Date Signed:
Telephone Number
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