Application For License Page 4

CHECKLIST

(Use this checklist to verify that the application is complete before mailing it to the Office of the Navajo Tax Commission)

ONTC

Office Use Only

Application Fee is enclosed ($100),

Proof of Insurance is enclosed,

Proof of Certification for All Vehicles is enclosed (Carriers & Refiners Only),

Proof of Inspection and Certification for All Vehicles is enclosed (Carriers & Distributors Only),

Proof of Valid State or Federal Carrier's License is enclosed (Carriers Only),

List of Authorized Drivers is enclosed (Carriers Only),

The required bond amount has been determined and is attached,

All required areas on the bond form have been completed,

All areas of the application have been completed,

The application has been signed.

Attach a copy of this check list with your application

Page 4 of 5

Office of the Navajo Tax Commission

P.O. Box 1903, Window Rock, AZ 86515

FET:

Ph: (928) 871-6681; Fax: (928) 871-7608

Application for License

Revised: 2/12/2002

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Parent category: Business