Transcription of ST/PROV - oregon.gov
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ST/PROV - oregon.gov
DO NOT WRITE IN SPACE ABOVEOREGON WEIGHT RECEIPT AND TAX IDENTIFIER APPLICATION(SEE INSTRUCTIONS ON REVERSE)DO NOT WRITE IN SPACE BELOWEFFECTIVE DATEPROOFED DATEPROOFED BYDATE KEYEDKEYED BYFEESRECEIPTREINSTATEMENTSUSPENSION459 TOTAL PAIDMLGFM12 FORM 735-9076 (1-18)CERTIFICATION: I HEREBY CERTIFY THAT THE STATEMENTS CONTAINED IN THIS APPLICATION ARE TRUE AND CORRECT; NO MATERIAL FACT HAS BEEN OMITTED; THERE IS NOT A PERSON HAVING ANY INTEREST, DIRECTLY OR INDIRECTLY, IN THE OWNERSHIP OF THIS OPERATION EXCEPT AS SPECIFIED ABOVE; AND THAT THE OWNERSHIP AS DESIGNATED WILL AT ALL TIMES HAVE FULL POSSESSION AND CONTROL OF ALL MOTOR VEHICLES OPERATED OR REGISTERED UNDER THIS NAMEDATETITLEOWNEDLEASEDSOLOAXLCOMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXLHUBKMREASON FOR APPLICATIONADD VEHICLERENEW VEHICLEAMEND VEHICLE (LIST VARIABLE BEING AMENDE)
do not write in space above. oregon weight receipt and tax identifier application (see instructions on reverse) do not write in space below. effective date
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