Form Irp 004 PDF Details

Form IRP 004 is a document used to request changes in the Illinois registration of a partnership. The form can be used to request a variety of changes, including the addition or removal of a partner, name change, and address change. Completing and submitting Form IRP 004 is an easy way to keep your Illinois business registration up-to-date. Make sure to submit your form as soon as any changes occur in your partnership!

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HAVE ANY OF YOUR VEHICLE REGISTRATIONS BEEN REVOKED OR SUSPENDED IN THE PAST FIVE YEARS?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)

As for AUTHORIZED SIGNATURE OF APPLICANT and REGISTRANTS STATEMENT OF INSURANCE, make sure you take a second look in this current part. These two could be the most significant ones in the file.

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