Form Mc 377 - Request For Waiver Of Interest Form - Motor Carrier Division

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Brian Sandoval
Troy L. Dillard
Motor Carrier Division
555 Wright Way
Carson City, NV 89711 – 0600
(775) 684-4711
Complete and sign this form to request a waiver of interest on your Nevada Special Fuel
Tax account. When completed, this form may be mailed or faxed to the Nevada Motor
Carrier Division.
I, ____________________________, do hereby request a waiver from the interest assessed on
my Nevada Special Fuel Tax account. My request is made pursuant to NRS 360A.070*. I
understand that pursuant to NAC 360A.160, the Nevada Motor Carrier Division may require
additional information from myself in order to grant the requested waiver.
Motor Carrier Account Name: ____________________________________________________
Motor Carrier Account Number: __________________________________________________
Title of Person Requesting Waiver: ________________________________________________
Mailing Address: ______________________________________________________________
Telephone: _________________ Fax: _________________ Email: ______________________
*Please attach any additional information that will support the circumstances that have occurred
that may have lead to the delinquency and the request for the waiver of interest.
CRITIERIA FOR WAIVERS: A carrier must not be considered habitually delinquent as
defined by NAC 366.005(6); a carrier’s records for the year prior to the request will be
reviewed by the Motor Carrier Division; all requests for waivers must be made within 30
days of notification of the delinquency and all other accounts a carrier has with the Motor
Carrier Division must be in good standing with the Division.
Printed Name
Date request received: ____________
Date request processed: __________
Waiver Granted: ___________
Processed by: ____________
MC377 (9/2010)


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