Form Mv-552a - Apportioned Registration Supplement Application
Download a blank fillable Form Mv-552a - Apportioned Registration Supplement Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Mv-552a - Apportioned Registration Supplement Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2APPORTIONED REGISTRATION
MV-552A (4-17)
SUPPLEMENT APPLICATION
Commercial Registration Section
P. O. Box 68286
Harrisburg, PA 17106-8286
A APPLICANT INFORMATION
www dmv pa gov
For Department Use Only
City
County
State
Zip
Acct #
Name of Applicant
Business Address
City
State
Zip
County
***USDOT#
Person to Contact Regarding Application
Mailing Address
****TIN/EIN
Registration Year
E-mail Address
New Vehicle Only
Registration Transfer with Weight Increase
Increase Weight on Vehicle Originally Registered at a Lower Weight
Delete Only
Registration Transfer
Telephone Number
Fax Number
Registration Transfer and Registration Plate Replacement
Lease Buy Out
B WEIGHTS
PA
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
IA
ID
IL
IN
kS
kY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
Ok
OR
RI
SC
SD
TN
Tx
UT
VA
VT
WA
WI
WV
WY
AB
BC
MB
NB
NF
NS
ON
PE
QC
Sk
C VEHICLE ADDITIONS
D DELETE OR TRANSFER
1)
1) Title #
Vehicle Identification Number
Equipment Number
Year
Make
Body Type*
Axes
Seats
Fuel**
TRANSFER
DELETE
Equipment Number
Unladen or Chassis Wt.
Gross Vehicle Weight
Gross Combination Weight
Purchase Price
Purchase Date
Factory Price
***USDOT#
****TIN/EIN
Vehicle Identification Number
Vehicle Owner (Lessor Name)
PA Registration Plate Number
UT Spec Truck
CO Miles
Will the designated carrier responsible for safety change during the year?
Current Registration Plate Number
NO
YES
NO
YES
YES
2) Title #
Vehicle Identification Number
Equipment Number
Year
Make
Body Type*
Axes
Seats
Fuel**
2)
TRANSFER
DELETE
Equipment Number
Unladen or Chassis Wt.
Gross Vehicle Weight
Gross Combination Weight
Purchase Price
Purchase Date
Factory Price
***USDOT#
****TIN/EIN
Vehicle Identification Number
Will the designated carrier responsible for safety change during the year?
Vehicle Owner (Lessor Name)
PA Registration Plate Number
UT Spec Truck
CO Miles
Current Registration Plate Number
YES
NO
YES
NO
YES
*Use one of the following designations for the Body Type:
BS – Bus
TR – Tractor
TK – Truck (Single)
** FUEL
D – Diesel
G – Gas
P - Propane
•••USDOT# - US Department of Transportation Number
••••TIN/EIN - Tax Identification Number/Employee Identification Number
H - Hybrid
N - Natural Gas
O - Other
E INSURANCE AND ACKNOWLEDGEMENT
I acknowledge that I may lose my operating privilege or vehicle registration for failure to maintain financial responsibility on the currently registered
Insurance Company Name
NAIC #
vehicle for the period of registration. My signature attests to my knowledge of all applicable State and Federal Motor Carrier safety laws and
regulations. My signature attests to the fact that this vehicle is a motor carrier vehicle and it has a current valid safety inspection. It also attests to
my knowledge of all applicable State and Federal Motor Carrier safety laws and regulations.
Policy Number
Effective Date
Expiration Date
By ____________________________________ Title ____________________________________ Date __________
Number of duplicate cab cards for each vehicle in the fleet _______
Owner or Authorized Representative
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal