Penndot Form Mv-550 - Apportioned Registration Application - Schedule A
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1
2APPORTIONED REGISTRATION
MV-550 (7-16)
APPLICATION - SCHEDULE A
For Department Use Only
Check One: Merge Fleets r Yes r No
Bureau of Motor Vehicles • Commercial Registration Section
www dmv pa gov
Identify Fleet Numbers to Merge: ___ ___ ___ ___ ___
P. O. Box 68286 • Harrisburg, PA 17106-8286
Applicant Information
TIN/EIN
Registrant Name
D.B.A.
Contact Name
USDOT #
Business Street Address
Mailing Street Address
E-mail Address
Acct #
City
County
State
Zip Code
City
County
State
Zip Code
Registration Year
Telephone Number
Fax Number
B
Vehicle Additions
Title #
Vehicle Identification Number
Equipment Number
Year
Make
Body Type
Axles
Seats
Fuel***
TIN/EIN
Purchase Date
USDOT #
Unladen Weight
Gross Vehicle Weight
Gross Combination Weight
Purchase Price
Factory Price
Will the designated carrier responsible for safety change during the year?
Vehicle Owner (Lessor Name)
PA Registration Plate Number
UT Spec Truck
CO Miles
q
q
q
q
YES
NO
YES
YES
NO
Year
Body Type
Axles
Fuel***
Title #
Vehicle Identification Number
Equipment Number
Make
Seats
TIN/EIN
Unladen Weight
Gross Combination Weight
Purchase Price
Purchase Date
Factory Price
USDOT #
Gross Vehicle Weight
Will the designated carrier responsible for safety change during the year?
Vehicle Owner (Lessor Name)
PA Registration Plate Number
UT Spec Truck
CO Miles
q
q
q
q
NO
YES
YES
YES
NO
NAIC #
Insurance Company Name
* BODY TYPE
** FUEL
Exempt Commodity:
Number of duplicate cab
cards for each vehicle
TR – Tractor
D – Diesel
N – Natural Gas
in the fleet:
TK – Truck (Single)
G – Gas
P – Propane
Policy Number
Effective Date
Expiration Date
BS – Bus
H – Hybrid
O – Other
I acknowledge that I may lose my operating privilege or vehicle registration for failure to maintain financial responsibility on the currently registered vehicle(s) for the period of registration. My signature attests to knowledge of all applicable state and
federal motor carrier laws, regulations and that the vehicle(s) has/have a current valid safety inspection.
By _______________________________________________________ By ____________________________________________________ Title ____________________________________________________ Date ______________________________________
Owner or Authorized Representative
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