IRP-6 Form – Fill Out and Use This PDF

Under Type of application requested, mark New account, Add vehicle, Delete vehicle, Transfer plates, Weight increase, Weight decrease, Renewal, Fleet to fleet, Duplicate cab card, Replacement plates, Replacement sticker, Safety DOT # change, Address change or Temporary authority, or write on the Other line.

Under REGISTRANT/CARRIER INFORMATION, enter the ACCOUNT # in box 1, the FLEET # in box 2 and the REGISTRANT NAME in box 3.

Enter the DBA in box 4.

Enter the BUSINESS ADDRESS in box 5 (No P.O. Box Number Allowed), then the CITY, STATE, ZIP CODE and COUNTY.

Enter the CONTACT PERSON in box 6, the PHONE # in box 7, the FAX # in box 8 and the EMAIL ADDRESS in box 9.

Mark Yes or No to: Do you want to receive your IRP Renewal Application and IRP notices electronically rather than by mail service?

Enter the TAXPAYER IDENTIFICATION # (TIN) in box 10 and the DATE OF BIRTH in box 11, and mark M, F or X for SEX in box 12.

Under PRIVACY ACT in box 13, check the INFORMATION DISCLOSURE box if you do not want your personal information from this record used for surveys, marketing and solicitations.

Enter the WYOMING AUTHORITY# in box 14 and the REGISTRANT'S DOT # in box 15. Mark Yes or No to: Have you previously been registered in any jurisdictions? If yes, write the jurisdiction. Mark Yes or No to: Do you lease your vehicle and driver to a motor carrier?

Under FLEET INFORMATION, enter the FLEET TYPE in box 16, the COMMODITY CLASS in box 17, the # OF REG MONTHS in box 18, the EFFECTIVE DATE in box 19, the EXPIRATION DATE in box 20 and the MAILING ADDRESS in box 21, then the CITY, STATE, ZIP CODE and COUNTY.

Under PART 2 FLEET TO FLEET TRANSFER INFORMATION, enter the VEHICLE UNIT # (OEN), the VEHICLE IDENTIFICATION NUMBER, the FROM FLEET # and the TO FLEET #.

Under DELETIONS*, enter the VEHICLE UNIT # (OEN), the VEHICLE IDENTIFICATION NUMBER, the LICENSE PLATE NUMBER and the REPLACEMENT VEHICLE UNIT # (OEN), and send in plates for deletion.

Under PART 3 WEIGHT INFORMATION, enter the Account # and list the weight you want on your cab card for all jurisdictions.

Canadian jurisdictions will print the weight in kilograms on the cab card.

Under Part 4, Vehicle information for new accounts, additions, or changes, enter the VEHICLE UNIT # (OEN) in box 31, then A) VEHICLE IDENTIFICATION NUMBER, B) YEAR, C) MAKE, D) VEHICLE TYPE, E) FUEL/CYL and F) WHEELBASE.

Enter G) UNLADEN WT, H) SEATS, I) AXLES, J) COMBINED AXLES and K) COLOR.

Enter L) OWNER NAME, M) TITLE DOC. # and N) TITLE DOC. JUR.

Enter O) SAFETY TAXPAYER ID # (TIN), P) SAFETY DOT # and R) SAFETY NAME.

Mark Yes or No to: Will vehicle safety responsibility change during the year?

Enter S) MAXIMUM DESIRED WEIGHT, T) PURCHASE PRICE, U) PURCHASE DATE, V) FACTORY PRICE, W) INS. CO. CODE, X) CURRENT PLATE #, Y) CURRENT PLATE CLASS and Z) SPECIAL USE.

IF THE REGISTRANT IS NOT THE OWNER, fill in Vehicle #1 - Owner's Name, Date of Birth, Address, Apt. No., City, State and Zip Code, and mark Yes or No to: Is the vehicle leased?

IF THE REGISTRANT IS NOT THE OWNER, proof of ownership and proof of the OWNER'S name and date of birth are required.

Sign as Owner's Authorized Signature and enter the Date: I authorize the person named in number 3 of Part 1 to register this vehicle.

If signing for a corporation, print your full name and title here.

The Undersigned certifies under penalty of perjury that all information provided in this Application is true and accurate to the best of the Undersigned's knowledge, and that the subject vehicle: is fully equipped, inspected, insured, and will be operated, in compliance with New York State Vehicle and Traffic Law (VTL); possesses a valid NYS inspection issued within the last twelve (12) months; or, in the alternative, has qualified for an extension of such inspection (see, DMV form VS-1077) and will be inspected within the next ten (10) days; is covered by a current policy of insurance or financial security as required by VTL; and if previously “junked”, has been repaired to conform with VTL Sections 375 and 376; possesses a currently valid NYS registration (if I am using this Application to request issuance of replacement registration documents).

The Undersigned declares that the Undersigned fully understands applicable Federal and NYS Motor Vehicle Carrier Safety laws and regulations including, where applicable, those pertaining to the transportation of hazardous materials.

If this Application is signed in my official capacity on behalf of a business entity, I further certify that I am duly authorized to make this Application on behalf of such entity.

By signing this Application, the Undersigned acknowledges that intentionally making a false statement on this form is a misdemeanor under VTL Section 392, and may result in criminal prosecution, as well as suspension or revocation of the registration of the subject vehicle.

If signing as agent for a business entity, write your title (CEO, President, Vice-President, Secretary, Treasurer or Comptroller).

Anyone else signing as agent for a business entity must send in a notarized Power of Attorney.