Reducible Load Permit Form – Fill Out and Use This PDF

State of Rhode Island - Division of Motor Vehicles
Reducible Load Permit Application	http://www.dmv.ri.gov

A. Owner And Vehicle Information

DATE

OWNER’S NAME

BUSINESS ADDRESS

TELEPHONE

VIN

MODEL YEAR

MAKE

REGISTRATION NUMBER

STATE

VEHICLE TYPE

BODY TYPE

REGISTERED

PERMIT

NUMBER OF

(SEE REVERSE)

(SEE REVERSE)

GROSS WEIGHT

WEIGHT SOUGHT

AXLES

AXLE LOAD RATINGS

AXEL SPACING

DISTANCE CENTER-

(1)

(2)

(3)

(4)

(1-2)

(2-3)

(3-4)

TO-CENTER OF

EXTREME AXLES

OVERALL LENGTH

OVERALL WIDTH

ANTICIPATED HAZARDOUS

COMMODITIES CARRIED

INSURANCE COMPANY

OF VEHICLE

OF VEHICLE

MATERIALS CARRIED?

(SEE REVERSE)

YES

NO

B. To Be Completed By Manufacturer Or Representative

Gross Vehicle Weight Rating (GVWR), in pounds, as provided by manufacturer or representative at the time of manufacture: _____________________.

Check one:	based on then current data sheets	based on applicable U.S. D.O.T. standards (FMVSS)
MANUFACTURER’S NAME			MANUFACTURER’S ADDRESS
REPRESENTATIVE’S NAME (IF APPLICABLE)			REPRESENTATIVE’S ADDRESS (IF APPLICABLE)
PERSON MAKING CERTIFICATION

I hereby state that I have read the above vehicle specifications and certify the same to be valid as the date of this application and that I am duly authorized by the manufacturer to make this certification.

Manufacturer ____________________________________________________________

By ____________________________________________________________

If unable to obtain manufacturer’s GVWR, attach statement from said manufacturer giving reasons why a rating cannot be provided.

DO NOT FILL OUT - DIVISION OF MOTOR VEHICLES ONLY - DO NOT FILL OUT

DATE RECEIVED: ____________________ THIS PERMIT IS ISSUED TO THE ABOVE VEHICLE FOR ________________ POUNDS.

GROSS VEHICLE WEIGHT RATING AS CERTIFIED BY MANUFACTURER ________________ POUNDS.

IF PERMITTED VEHICLE IS A SEMI-TRAILER, IT MAY BE COUPLED WITH OTHER VEHICLES IN ACCORDANCE WITH SECTION 31-25-6 WITH A PERMIT WEIGHT EQUAL TO THE LESSER OF THE COMBINED GROSS VEHICLE WEIGHT RATINGS, IN NO EVEN TO EXCEED _______________ POUNDS GROSS WITH A MINIMUM OF __________

AXLES.

THIS PERMIT DOES NOT AUTHORIZE TRAVEL OVER ANY HIGHWAY OR PORTION OF ANY HIGHWAY WITH A POSTED WEIGHT LIMIT. THIS PERMIT IS ISSUED IN ACCORDANCE WITH APPLICABLE SECTIONS OF THE RHODE ISLAND MOTOR VEHICLE CODE ACT AND IN ACCORDANCE WITH RULES AND REGULATIONS PROMULGATED BY THE DIRECTOR OF TRANSPORTATION.

DOT PERMIT # : ____________________	DATE ISSUED: ____________________	DATE EXPIRES: ____________________
ADMINISTRATOR OF MOTOR VEHICLES: ____________________ CLERK: ____________________			DATE: ____________________ FEE: ____________________

PERMIT NOT VALID UNTIL STAMPED OR SIGNED BY ADMINISTRATOR OF MOTOR VEHICLES OR HIS/HER DESIGNEES.

THIS PERMIT MUST BE CARRIED WITH THE VEHICLE AT ALL TIMES.

C. Applicant’s Certification

I hereby declare under penalties provided by the General Laws of Rhode Island that to the best of my knowledge no alterations have been made to this vehicle which would tend to reduce the said gross vehicle weight rating and that the chassis, axles, tires, rims, brakes, steering components and the suspension systems are maintained in good order. The undersigned hereby certifies that all information contained in this application is true and correct to the best of my knowledge and belief. I acknowledge that false statements are punishable by fine, imprisonment or both. This certification does not apply to the information provided in areas under the OWNER AND VEHICLE INFORMATION labeled, “commodities carried,” “anticipated hazardous materials carried,” and “reason for application.”

Personal information contained in your motor vehicle record will be disclosed only if the state has obtained the express consent of the person to who such personal information pertains.

DO YOU CONSENT TO SUCH A DISCLOSURE?

YES

NO

OWNER’S SIGNATURE

PRINT OR TYPE FULL NAME

ADDITIONAL INFORMATION ON REVERSE SIDE