Form Irp 004 PDF Details

Navigating the logistics of operating commercial vehicles across state lines can often be a complex process, but the International Registration Plan (IRP) aims to streamline this necessity. Specifically, the IRP-004 form plays a crucial role for commercial vehicle operators within West Virginia, offering a much-needed solution for those who find themselves in the unfortunate position of needing a duplicate apportioned cab card, license plate, or decals. This application is thoughtfully designed to address scenarios where the original documents have been lost, destroyed, or stolen. The West Virginia Division of Motor Vehicles requires applicants to satisfy several conditions, including a declaration that the loss occurred, providing an avenue for the issuance of duplicates. The form, succinct in its layout, requests detailed information about the registrant, the fleet, and the specific vehicle in question, incorporating a modest fee structure for the processing of duplicate documents. Additionally, it emphasizes the importance of honesty and legal compliance, particularly concerning the vehicle's insurance status and history of registration revocations or suspensions, aiming to ensure that all commercial vehicles on the road are properly insured and have a legitimate right to operate. By mandating this comprehensive yet straightforward procedure, the IRP-004 form embodies a key component of the state’s effort to maintain a safe, legal, and efficient transportation network.

QuestionAnswer
Form NameForm Irp 004
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameswv irp renewal online, FALSE, apportioned, 17A

Form Preview Example

IRP-004

REV 8/07

WEST VIRGINIA DIVISION OF MOTOR VEHICLES

INTERNATIONAL REGISTRATION PLAN

STATE CAPITAL BUILDING 3

CHARLESTON WEST VIRGINIA 25317

This application is to be used in applying for a duplicate apportioned cab card, license plate or decals. A new cab card, license plate or decal will be issued if the Commissioner is satisfied the original is lost, destroyed or stolen, and upon certification to that effect.

PLEASE PRINT OR TYPE

ACCOUNT #

 

 

FLEET #

NAME OF REGISTRANT

 

 

 

 

 

 

 

 

 

BUSINESS ADDRESS (physical location of fleet)

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

 

MAILING ADDRESS (do not write “same”)

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

EQUIPMENT #

 

VEHICLE IDENTIFICATION #

 

 

 

TITLE #

APPORTIONED LICENSE NUMBER

 

 

 

IF DUPLICATE CAB CARD IS DESIRED CHECK HERE

_______ FEE $5.00

IF DUPLICATE YEARLY DECAL IS DESIRED CHECK HERE

_______ FEE $5.00

IF DUPLICATE PLATE IS DESIRED CHECK HERE

_______ FEE $5.00

GIVE REASON FOR REPLACEMENT: ______________________________________

HAVE ANY OF YOUR VEHICLE REGISTRATIONS BEEN REVOKED OR SUSPENDED IN THE PAST FIVE YEARS? YES_____OR NO____ IF YES GIVE REASON ________________________________________________

REGISTRANT’S STATEMENT OF INSURANCE

I HEREBY STATE, UNDER PENALTY OF FALSE SWEARING AND PENALTIES OUTLINED IN CHAPTERS 17A AND 17D, THAT THERE IS IN EFFECT A MOTOR VEHICLE LIABILITY POLICY UPON THE DESCRIBED VEHICLE IN ACCORDANCE WITH THE PROVISION OF WEST VIRGINIA MOTOR VEHICLE CODE.

EFFECTIVE DATE OF INSURANCE POLICY_______________ TO ____________

NAME OF INSURANCE COMPANY________________________________________

NAME OF INSURANCE AGENT ___________________________________________

POLICY NUMBER________________________________________________________

I HEREBY CERTIFY, UNDER PENALTY OF FALSE SWEARING, THAT THE STATEMENT MADE HEREIN ARE THE TRUE AND CORRECT TO THE BEST OF MY KNOLEDGE AND BELIEF.

__________________________________________________________________________________________________

AUTHORIZED SIGNATURE OF APPLICANT

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Filling out part 1 in REGISTRANT

2. Given that this segment is done, you have to include the required details in BUSINESS ADDRESS physical location, REGISTRANTS STATEMENT OF INSURANCE, I HEREBY STATE UNDER PENALTY OF, and AUTHORIZED SIGNATURE OF APPLICANT so you're able to progress further.

REGISTRANT completion process outlined (part 2)

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