Transcription of VEHICLE APPLICATION: SCHEDULE B LICENSE YEAR
1 MOTOR CARRIER DIVISION. 555 WRIGHT WAY. CARSON CITY, NV 89711-0600. (775) 684-4711. fax (775) 684-4619. VEHICLE APPLICATION: SCHEDULE B LICENSE YEAR. TRANS CODE VEHICLE FUEL. ACCOUNT # FLEET # (1) (7) (8) OFFICE USE ONLY. FULL LEGAL NAME. A-ADD TR-TRACTOR D-DIESEL. ADDRESS NO. OF REG> MOS. TK-TRUCK. C-CHANGE G-GAS. CITY, STATE, ZIP (SINGLE) SUPP. NO. D-DELETE BS-BUS P-PROPANE. Check here for address change IFTA IRP NV Only Permanent Trailer (only full & semi-trailers) DATE. ST-SEMI. R-REFUND O-OTHER. TRAILER INITIALS. FT-FULL. All fields below must be completed. Please write N/A for fields that do not apply: T-TRANSFER. TRAILER. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18. TRANS NEVADA PLATE # OPERATOR'S YEAR AND SERIAL OR VIN # VEHICLE FUEL #OF #OF UNLADEN COMBINED ACTUAL ORIGINAL PURCHASE LEASE DATE LESSOR STATE. CODE COUNTY VEHICLE #/ MAKE TYPE TYPE AXLES/ COMBINED WEIGHT DECLARED PURCHASE PURCHASE DATE TITLED.
2 UNIT # SEATS AXLES GROSS WEIGHT PRICE PRICE OR. FACTORY PRICE. NUMBER OF IFTA DECALS IF REQUIRED? IF MORE THAN THE VEHICLES LISTED ABOVE PLEASE EXPLAIN. UNDER PENALTIES OF PERJURY, THE APPLICANT DECLARES THAT THE INFORMATION GIVEN IS TO THE BEST OF THE APPLICANT'S KNOWLEDGE TRUE, ACCURATE AND COMPLETE. THE APPLICANT AGREES TO COMPLY WITH REPORTING, PAYMENT, RECORD KEEPING AND LICENSE DISPLAY REQUIREMENTS AS SPECIFIED IN THE INTERNATIONAL FUEL TAX AGREEMENT, THE INTERNATIONAL REGISTRATION PLAN, AND THE NEVADA REVISED STATUTES. THE APPLICANT. FURTHER AGREES THAT THE MOTOR CARRIER DIVISION MAY WITHHOLD ANY REFUNDS DUE IF THE APPLICANT IS DELINQUENT ON PAYMENT OF ANY FEES DUE THE DEPARTMENT OR FUEL TAXES DUE TO ANY MEMBER JURISDICTIONS. FAILURE TO COMPLY WITH THESE PROVISIONS SHALL BE GROUNDS FOR REVOCATION OF LICENSE IN NEVADA AND ALL MEMBER JURISDICTIONS. THE APPLICANT UNDERSTANDS AND AGREES TO COMPLY WITH THE HAZARDOUS.
3 MATERIAL AND MOTOR CARRIER SAFETY REGULATIONS. THE APPLICANT AGREES TO MAINTAIN INSURANCE PURSUANT TO NRS AND AND WILL COMPLY WITH THE MOTOR CARRIER SAFETY REGULATIONS. Full Legal Name Signature Title Date Telephone # ( ). APPLICATION MUST BE SIGNED OR IT WILL BE RETURNED TO YOU. MC003 (08/2014).
