Irp Form T-139 - Georgia Irp Mileage Schedule A Page 4

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IRP Vehicle Schedule A Form T-138 Instructions (Continued) - ( Rev. 4/2013)

Page 4 of 4

Combined Gross

Weight: For vehicles in combination, record the combined weight of the tractor, trailer, and the heaviest cargo that the vehicle can carry. This weight should

be the same as you declared for the Federal Highway Vehicle Use Tax and as shown on your vehicle’s ad valorem tax receipt. Please do not show a combined gross weight

for trailers.

Vehicle’s Purchase Price: Record the price the current owner paid for the vehicle minus any trade-in, sales or use tax and finance charges.

Factory List Price: Record the vehicle’s factory list price. Please do not include cents.

Owner’s Name: Record the vehicle owners’ names as they appear on the vehicle’s title. For vehicles under a lease, enter the leasing company’s name as it appears on the

vehicle’s title.

GA Title #: Record the vehicle’s valid Georgia title number in this field. Out-of-state title numbers are not acceptable.

10.

Short Term Lease: Record a ‘Y’ for ‘Yes’ if the vehicle will be rented or leased for less than thirty (30) days to a Motor Carrier.

Motor Carrier’s Federal Employer Identification Number (FEIN):

11.

Record Motor Carrier’s Federal Employer Identification Number (F.E.I.N).

12.

U.S. D.O.T. Number: Record the Carrier’s U.S. D.O.T. Number. The Motor Carrier is required to up-date their Motor Carrier Identification Report (Form MCS-150) annually.

A U.S. D.O.T. number can be applied for or a Motor Carrier Services Identification Report (Form T-MCS-150) updated from the Federal Motor Carriers Safety Administration’s

website, From their website, click on ‘FMCSA Registration & Updates’. Motor carrier forms not updated within the last year will not be accepted.

Section 4

1. Signature, Printed Name, Position or Job Title & Date: The Registrant/Carrier or his/her authorized agent is required to sign this completed application, type or print his/her

name, enter his/her position or job title with the company, and record the date (month, day and year) signed.

Please do not remit money with this application. You will be billed later.

Applications for Georgia IRP registration may be submitted by mail or in-person as follows:

Mailing Address: ATTN: Commercial Vehicle - IRP Section, Department of Revenue, Motor Vehicle Division, P . O. Box 740382, Atlanta, Georgia 30374-0382

In-Person Address: Commercial Vehicle – IRP Section Window, Department of Revenue, Motor Vehicle Division, 4125 Welcome All Rd, Atlanta, Georgia 30349

Office open from 7:30 a.m. to 4:30 p.m. Monday through Friday, excluding

state

holidays.

Georgia IRP Section’s Telephone Number: 1-855-406-5221

E-Mail Address:

commercial.vehicles@dor.ga.gov

Department of Revenue’s Website:

https://etax.dor.ga.gov