IRP-6: International Registration Plan Schedule A & C

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 U.S. DOT # Change, Address Change, Temporary Authority or Other, and write on the line after Other.

Enter the Account # in Box 1 and the Fleet # in Box 2.

Enter the Registrant Name in Box 3.

Enter the DBA in Box 4.

In Box 5, enter the Business Address (No P.O. Box Number Allowed), with 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 for: 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.

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.

If you have one, enter the Wyoming Authority# in Box 14; enter the Registrant's DOT # in Box 15.

Mark Yes or No for: Have you previously been registered in any jurisdictions? If yes, enter the jurisdiction.

Mark Yes or No for: 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 and the # of Reg Months in Box 18.

Enter the Effective Date in Box 19 and the Expiration Date in Box 20.

In Box 21, enter the Mailing Address with 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). Send in plates for deletion.

In Part 3, Weight Information, enter the Account # and, in Box 30, the weight you want on your cab card for all jurisdictions.

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

In Part 4, Vehicle Information for New Accounts, Additions, or Changes, enter the Vehicle Unit # (OEN) in Box 31 and 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) and P) Safety U.S. DOT #.

Mark Yes or No for Q): Will vehicle safety responsibility change during the year? Then enter R) Safety Name.

Enter S) Maximum Desired Weight, T) Purchase Price, U) Purchase Date and V) Factory Price.

Enter W) Ins. Co. Code, X) Current Plate #, Y) Current Plate Class and Z) Special Use.

Under Registration Authorization, if the registrant is not the owner, fill in the Vehicle #1 Owner's Name, Date of Birth, Address, Apt. No., City, State and Zip Code.

Mark Yes or No for: Is the vehicle leased?

The owner signs on the Owner's Authorized Signature line and enters the Date to 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.

By signing you certify under penalty of perjury that all information provided in this Application is true and accurate to the best of your 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 you are using this Application to request issuance of replacement registration documents).

By signing you declare that you fully understand 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 your official capacity on behalf of a business entity, you further certify that you are 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.

Print the Name of Applicant/Business Entity (please print), sign on the Sign here: X line, and enter the Title and the Date (mm/dd/yyyy).