Dmv Form Mc011 PDF Details

The Department of Motor Vehicles (DMV) Form Mc011 is a verification form that is used to check the validity of driver's licenses. The form can be used for both personal and business purposes. The form requires the name and driver's license number of the person being checked, as well as the name and state of issuance of the driver's license. The DMV Form Mc011 can be obtained from your local DMV office or from the DMV website.

QuestionAnswer
Form NameDmv Form Mc011
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmc011 mc 011 fillable form

Form Preview Example

MOTOR CARRIER DIVISION 555 WRIGHT WAY CARSON CITY, NV 89711-0600 (775) 684-4711 Fax (775) 684-4619 www.dmvnv.com

LICENSING APPLICATION: SCHEDULE A

Section A: Licensing Information:

LICENSE YEAR: 20

 

 

 

Company Name (Legal Business Name)

Secretary of State - Business License Number

Account Number

Federal DOT Number (if applicable)

Principal’s Full Legal Name and Title

 

 

 

Principal’s Driver License Number

 

NOTE: If the principal’s driver license was not issued by the State of Nevada, please remit a photocopy of the license to the Motor Carrier Division with this application.

 

 

 

 

 

 

 

 

 

Principal’s Address

 

 

 

City

 

State

Zip

 

 

 

 

 

 

 

INDICATE TYPES OF LICENSING REQUIRED

INDICATE TYPE OF OPERATION

INDICATE TYPE OF

 

PAYMENT OPTION FOR

 

 

 

 

 

APPLICATION

 

ORIGINAL OR RENEWAL ONLY

100% NEVADA ONLY

PRIVATE

 

 

 

 

 

 

 

 

 

 

IRP

FOR HIRE:

 

 

 

ORIGINAL

 

FULL

IFTA

EXEMPT /

REGULATED

RENEWAL

 

PARTIAL

SPECIAL MOBILE EQUIPMENT

HOUSEHOLD GOODS

 

SUPPLEMENT

 

 

INTRASTATE AUTHORITY

RENTAL COMPANY

 

 

 

 

 

Section B: General Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Physical Address

 

 

 

City

 

State

Zip

 

 

 

 

 

 

 

 

Mailing Address (If different from the physical)

 

 

 

City

 

State

Zip

 

 

 

 

 

 

 

DBA (If used in this state)

 

 

 

Federal Employer Identification Number (FEIN)

 

 

 

 

 

(

)

 

 

 

Contact / Principal’s Name and Title

 

 

 

 

 

Phone #

 

 

 

 

(

)

 

 

 

E-Mail Address

 

 

 

 

 

Fax #

 

Section C: Additional Information:

 

 

 

 

 

 

 

 

1. Was this carrier previously registered in another jurisdiction?

No:

Yes:

If “Yes” where?

 

 

2.Location of Records (Physical Address):

 

 

City

State

Zip

 

In the spaces below, please list all owners, partners, and/or corporate officers and their titles (attach additional sheets if necessary):

3.

1)

2)

3)

 

Full Legal Name and Title

Full Legal Name and Title

 

Full Legal Name and Title

 

 

 

4)

5)

6)

 

 

Full Legal Name and Title

Full Legal Name and Title

 

Full Legal Name and Title

Have you or any of your corporate officers or partners ever held a license under a different name or FEIN?

No:

4.

 

If “Yes” list name, FEIN, Account #, and State:

 

Licensing Agent/Reporting Service Name:

 

Lic. Agent/Reporting Svc. Mailing Address:

 

Yes:

5.

 

 

 

 

 

 

 

City

State

Zip

(

)

 

 

 

(

)

 

 

Licensing Agent/Reporting Service Phone

 

 

 

 

 

 

Licensing Agent/Reporting Service Fax #

 

 

Are Tax Returns to be mailed to the reporting service?

No:

Yes:

 

 

 

Do you maintain bulk fuel storage tanks?

No:

Yes:

 

 

 

 

 

6.

 

 

 

 

 

 

 

 

 

 

 

If “Yes” location

 

 

 

 

 

 

Tank Capacity

 

List additional locations and tank capacities on the back of this application

Do you sell fuel in Nevada?

No:

7.

 

 

Gasoline

Gasohol

E85

Yes:

Jet Fuel

If “Yes” please indicate the types of fuels sold by selecting the boxes below:

 

Aviation Fuel

Diesel

Biodiesel

LPG

CNG

A55

Kerosene

Are you consolidating out of state fleets with your Nevada IFTA?

No:

Yes:

8.

If yes, please enter the number of non-Nevada Qualified Motor Vehicles:

You must provide written approval from that jurisdiction(s) and copies of all IRP cab cards on qualified vehicles being consolidated in Nevada.

NOTE: Any vehicles with mileage accrued during the reporting period and/or registered in another jurisdiction MUST be registered with actual mileage, unless otherwise approved in writing by the Appointing Authority or designee.

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 as applicable. 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 agrees to maintain insurance pursuant to NRS 485.185 and 706.291 and will comply with the Motor Carrier Safety Regulations.

PLEASE NOTE: THIS APPLICATION MUST BE SIGNED OR IT WILL BE RETURNED TO YOU

Printed Full Legal Name (and title if applicable)

Signature

Date

()

Phone #

E-Mail Address

For Office Use Only

Date Received

Date Approved

Date Issued

Initials

Account #

Fleet #

MC011 (9/2010)

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As for the blanks of this particular document, here's what you need to know:

1. To start with, once filling in the Dmv Form Mc011, start in the part with the following fields:

Dmv Form Mc011 completion process shown (portion 1)

2. When this section is done, go to type in the relevant information in these: City, City, State, State, Zip, Zip, Federal Employer Identification, Phone, Fax, Physical Address, Mailing Address If different from, DBA If used in this state Contact, EMail Address Section C Additional, Was this carrier previously, and Yes.

Ways to fill in Dmv Form Mc011 step 2

3. The next step will be hassle-free - fill in all of the blanks in Lic AgentReporting Svc Mailing, Licensing AgentReporting Service, City, State, Zip, Licensing AgentReporting Service, Are Tax Returns to be mailed to, Yes, Do you maintain bulk fuel storage, If Yes location, Yes, List additional locations and tank, Tank Capacity, Do you sell fuel in Nevada Gasoline, and Gasohol to conclude this part.

How to fill in Dmv Form Mc011 step 3

People often make some errors when filling out Licensing AgentReporting Service in this part. Be sure you go over everything you enter here.

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