NAME OF REGISTRANT TYPE OF TYPE OF U.S.

DOT
PLEASE TYPE OR PRINT WITH INK APPLICATION OPERATION NUMBER
FLORIDA BUSINESS ADDRESS (DO NOT USE P.O. BOX)
INTERNATIONAL REGISTRATION PLAN  ORIGINAL
 RENEWAL  EXEMPT COMMODITY
CITY COUNTY STATE ZIP CODE FLORIDA APPLICATION  ADD FLEET
CARRIER
FLORIDA
MAILING ADDRESS SCHEDULE A  ADD STATE  HOUSEHOLD GOODS
FEI #
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
 ADD VEHICLE CARRIER
CITY COUNTY STATE ZIP CODE BUREAU OF MOTOR CARRIER SERVICES  TRANSFER
(THIS # IS REQUIRED
TO REFERENCE YOUR
 INCREASE  FOR HIRE CARRIER
Neil Kirkman Building, MS-62 IFTA ACCOUNT)
WEIGHT
PERSON TO CONTACT REGARDING APPLICATION TELEPHONE 2900 Apalachee Parkway
NUMBER  CORRECTION  PRIVATE CARRIER
Tallahassee, Florida 32399-0626
Telephone (850) 617-3711  FLEET TO FLEET (OWNS GOODS BEING
TRANSPORTED)
IF THE ABOVE ADDRESSES OR TELEPHONE NUMBER ARE DIFFERENT FROM
TRANSFER
WHAT WAS ON YOUR PREVIOUS APPLICATION PLEASE CHECK THIS BOX:  http://www.flhsmv.gov
TRANSACTION TYPES VEHICLE TYPES FUEL TYPES
O – ORIGINAL A – ADD VEHICLE TT – TRUCK TRACTOR TK – TRUCK (SINGLE)
D – DIESEL G – GAS P - PROPANE
C – CORRECTION D – DELETE VEHICLE TR – TRACTOR BS – BUS
IRP ACCOUNT NUMBER FLEET NUMBER LICENSE YEAR
VEHICLE INFORMATION
A S
Y M T F GROSS OR
TRANS- OWNER’S VEHICLE X E TITLE
E A Y U VEHICLE COMBINED EMPTY DATE OF OWNER’S FACTORY NAME OF OWNER COLORADO
ACTION UNIT IDENTIFICATION L A NUMBER
A K P E COLOR GROSS WEIGHT PURCHASE PURCHASE LIST (AS IT APPEARS ON TITLE) LOW
TYPE NUMBER NUMBER E T AND
R E E L WEIGHT (M / D / Y) PRICE PRICE MILEAGE
S S STATE

PLEASE BE SURE  PROOF OF OWNERSHIP PLEASE DO NOT SEND

YOU PRINTED YOUR NAME,  COPY OF LEASE, IF APPLICABLE MONEY WITH THIS
SIGNED THE APPLICATION,  SIGNED APPLICATION AND PRINTED NAME APPLICATION. A BILL WILL
BE CALCULATED AND
AND ENCLOSED THE  PROOF OF ESTABLISHED PLACE OF BUSINESS MAILED TO YOU.
FOLLOWING REQUIRED  PROOF OF PAYMENT OF HEAVY VEHICLE USE TAX (IRS FORM 2290) EARLY APPLICANTS WILL
DOCUMENTATION, AS NECESSARY.  PROOF OF BODILY INJURY AND PROPERTY DAMAGE LIABILITY INSURANCE BE GIVEN PRIORITY.

HSMV 85900 (Rev. 4/08)

 SCHEDULE B – WEIGHT INFORMATION AND MILEAGE
SCHEDULE OF FLEET MILEAGE FOR THE PERIOD
UNITS LISTED WILL BE AUTHORIZED TO Will you be operating intrastate in the state of Wyoming?
JULY 1, ________ THROUGH JUNE 30, ________
OPERATE IN THE JURISDICTIONS AND AT THE WEIGHTS
LISTED BELOW
PLEASE NOTE: IF MILEAGE IS NOT INDICATED FOR AN APPORTIONED YES  NO  (Please  one)
STATE, YOU WILL NOT BE APPORTIONED TO TRAVEL IN THAT STATE.
ACTUAL ESTIMATED INACTIVE ACTUAL ESTIMATED INACTIVE ACTUAL ESTIMATED INACTIVE
JURISDICTION MILES MILES MILES
GVW JURISDICTION MILES MILES MILES
GVW JURISDICTION MILES MILES MILES
GVW

FL – FLORIDA MI – MICHIGAN TX – TEXAS

AL – ALABAMA MN – MINNESOTA UT – UTAH
AK - ALASKA MO – MISSOURI VA – VIRGINIA
AR – ARKANSAS MS – MISSISSIPPI VT – VERMONT
AZ – ARIZONA MT – MONTANA WA – WASHINGTON
CA – CALIFORNIA NC – NORTH CAROLINA WI – WISCONSIN

CO – COLORADO ND – NORTH DAKOTA WV – WEST VIRGINIA

CT – CONNECTICUT NE – NEBRASKA WY – WYOMING

DC – DIST. OF COLUMBIA NH – NEW HAMPSHIRE AB – ALBERTA

DE – DELAWARE NJ – NEW JERSEY BC – BRITISH COLUMBIA

GA – GEORGIA NM – NEW MEXICO MB – MANITOBA

IA – IOWA NV – NEVADA MX – MEXICO

ID – IDAHO NY – NEW YORK NB – NEW BRUNSWICK

IL – ILLINOIS OH – OHIO NL – NEWFOUND/LABRA.

IN – INDIANA OK – OKLAHOMA NS – NOVA SCOTIA

KS – KANSAS OR – OREGON NT – NW TERRITORY

KY – KENTUCKY PA – PENNSYLVANIA ON – ONTARIO

LA – LOUISIANA RI – RHODE ISLAND PE – PRINCE ED. ISL.

MA – MASSACHUSETTS SC – SOUTH CAROLINA PQ – QUEBEC

MD – MARYLAND SD – SOUTH DAKOTA SK – SASKATCHEWAN

ME - MAINE TN – TENNESSEE YT - YUKON

I certify that the information furnished in this application and the attachments is true and correct. I further certify ADD ACTUAL MILEAGE AND ENTER TOTAL IN BOX A TOTAL ACTUAL FLEET MILES A
that I have read and understand the records retention requirements for the International Registration Plan and will PLEASE DO NOT SEND MONEY
comply with them. WITH THIS APPLICATION. ADD ESTIMATED MILEAGE AND ENTER TOTAL IN BOX B TOTAL ESTIMATED FLEET MIILES B
A BILL WILL BE CALCULATED
PRINTED AND MAILED TO YOU. ENTER COMBINED TOTAL OF A AND B IN BOX C TOTAL ACTUAL MILES + ESTIMATED MILES C
NAME______________________________________SIGNATURE___________________________________ EXPLANATION OF ESTIMATED MILEAGE: (Attach additional sheets of paper, if necessary.)
TITLE________________________________________________DATE________________________________ EARLY APPLICANTS
WILL BE GIVEN
THIS APPLICATION MUST BE SIGNED BY THE REGISTRANT UNLESS REGISTRANT SUBMITS A POWER PRIORITY
OF ATTORNEY DESIGNATING THE PERSON SIGNING AS AN AUTHORIZED AGENT. EMAIL ADDRESS (OPTIONAL):
HSMV 85900 (Rev. 4/08)