Form Tmt-1 - Application For Highway Use Tax (Hut) And Automotive Fuel Carrier (Afc) Certificates Of Registration Page 2

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TMT-1 (4/11) (back)
Legal name
Taxpayer
Employer identification number (EIN) Suffix, if any
Social security number
identification
OR
SS
number
17. Certificates of registration (credentials) are requested for the following vehicles. List each vehicle separately. Group separately trucks, tractors, and automotive fuel carrier trailers. Use a continuation
sheet (Form TMT-1.1, Continuation Sheet for Form TMT-1) for additional vehicles.
Type or print your entries in ink.
A
B
C
D
E
F
G
H
I
J
K
L
Mark X in
Certificate
Manufacturer’s
Type of
Type of
Make of
Year
Unloaded
Gross
Own
Owner
State and license
type
Vehicle identification number ( VIN )
vehicle
fuel
vehicle
weight
weight
or
equipment
plate number
box if
of vehicle
of vehicle
lease
number
(required; see instr.)
temporary
plate no.
( optional )
State
Plate number
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None
Diesel
Tractor
Own
Gas
Truck
Other
Lease
Trailer (AFC)
None

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