Form Irp-6 - International Registration Plan - Schedule A&c

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New York State Department of Motor Vehicles
IRP-6 (7/07)
PAGE 1 OF 2
INTERNATIONAL REGISTRATION PLAN
SCHEDULE A & C
PART 1
TYPE OF APPLICATION REQUESTED
NEW ACCOUNT
ADD JURISDICTIONS
DUPLICATE CAB CARD
ADDRESS CHANGE
ADD VEHICLE
WEIGHT INCREASE
REPLACEMENT PLATES
TEMPORARY AUTHORITY
DELETE VEHICLE
WEIGHT DECREASE
REPLACEMENT STICKER
OTHER____________________
TRANSFER PLATES
RENEWAL
FLEET TO FLEET
CARRIER INFORMATION
DMV USE ONLY
SUPP#: __________________
1. ACCOUNT # ____________________
2. FLEET # ____________________
3. CARRIER NAME: ____________________________________________________________________________________
4. DBA: ______________________________________________________________________________________________
5. BUSINESS ADDRESS: ________________________________________________________________________________
(No P.O. Box Number Allowed)
CITY: ______________________
STATE: _______
ZIP CODE: ______________
COUNTY: ____________________
6. CONTACT PERSON: ________________________________________
7. PHONE # (
) ____________________
8. FEDERAL EMPLOYEE ID # or SSI #: _______________________________
9. FAX # (
) ____________________
10. DATE OF BIRTH: ____________________
11.
Male
Female
12. PRIVACY ACT: Check the INFORMATION DISCLOSURE box at the end of this sentence if you do not want your personal
information from this record used for surveys, marketing and solicitations.
13. WY AUTHORITY#:____________________________
14. US DOT#:____________________________
If you have ever been registered as IRP in another jurisdiction, what are those jurisdictions?____________________________
Do you lease your vehicle and driver to a motor carrier? ________________
DMV USE ONLY
FLEET INFORMATION
SP COND: AT, PA , S S , X R
15. FLEET TYPE: ____
16. COMMODITY CLASS:____
17. # OF REG MONTHS: ______
18. EFFECTIVE DATE:_______________
19. EXPIRATION DATE:_____________
20. MAILING ADDRESS: __________________________________________________________________________________
(No P.O. Box Number Allowed)
CITY: ______________________
STATE: _______
ZIP CODE: ______________
COUNTY: ____________________
PART 2
FLEET TO FLEET TRANSFER INFORMATION
(21)
(22)
(23)
(24)
(25)
OWNER
CREDIT
EQUIPMENT #
VEHICLE IDENTIFICATION NUMBER
FROM FLEET #
TO FLEET #
OLD/NEW FLEET
DELETIONS*
(26)
(27)
(28)
(29)
OWNER
LICENSE
REPLACEMENT OWNER
EQUIPMENT #
VEHICLE IDENTIFICATION NUMBER
PLATE NUMBER
EQUIPMENT #
*(Send in original cab cards and plates for deletions and original cab cards for transfer.)

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