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Cancellation Of License Form MCT-627 - Indiana

Cancellation Of License Form Form. This is a Indiana form and can be used in Motor Carrier Department Of Revenue Statewide .
 Fillable pdf Last Modified 4/19/2007
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INDIANA DEPARTMENT OF REVENUE MOTOR CARRIER SERVICES DIVISION INDIANA REVENUE FORM 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. 2. 3. 4. TID: IFTA License Number: INMotor Carrier Fuel Tax Permit Number: INOther: Typed or Printed Name: Date Signed: Title: Telephone Number Signature: American LegalNet, Inc. www.FormsWorkflow.com
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