Form M-233st - Special Weight Single Trip Applicaton
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1Indiana Department of Revenue
FORM M-233ST
Fee: $42.50
State Form 944
Special Weight
(R8 / 1-08)
Single Trip Applicaton
FEIN/SSN#
Name of Transporting Company:
Telephone Number
Street Address
City:
State:
ZIP:
Start Date
Start Time
Fax Number
State Plated
Make of Tractor
ModelYear:
Full Vehicle Identifi cation Number
License Plate Number
Vehicle Type
Truck-Trailer
Tractor-Trailer
Other Towed
Overall Length:
Legal
Overall Width: Legal
Overall Height: Legal
Allowable Weights: Single axle weight must not exceed 18,000 pounds per axle; no axle in any axle combination may exceed 13,000
pounds per axle, with the exception of one tandem group that may weigh 16,000 pounds per axle or a total of 32,000 pounds. The
maximum gross weight must not exceed 134,000 pounds for routes 1-21 below and 90,000 lbs for route 22 below; axle spacings may
not be less than 3'6" between each axle in an axle combination; axle spacings may not be less than 8 feet between each axle or axle
combination; weight per inch width of tire measured between fl anges of rim shall not exceed 800 pounds.
No detours allowed unless by proper authorities or the permit offi ce of INDOT offi cials.
The Permit is Valid Over State Roads: (1) US 41, from 129th Street in Hammond to SR 312, (2) Highway 312, from Highway 41
to State Road 912, (3) Highway 912, from Michigan Avenue to Highway 912 (Dickey and Riley Rd) to US20 interchange in East
Chicago, (4) Highway 20, from Clark Road in Gary to Highway 39, (5) Highway 12, from one-fourth (1/4) mile west of the Midwest
Steel entrance to Highway 249, (6) Highway 249, from Highway 12 to Highway 20, (7) Highway 12, from one and one-half (1 1/2)
miles east of the Bethlehem Steel entrance to Highway 149, (8) Highway 149, from Highway 12 to a point thirty-six hundredths (.36)
of a mile south of Highway 20, (9) Highway 39, from Highway 20 to the Michigan state line, (10) Highway 20, from Highway 39 to
Highway 2, (11) Highway 2, from Highway 20 to Highway 31, (12) Highway 31, from the Michigan state line to Highway 23, (13)
Highway 23, from Highway 31 to Olive Street in South Bend, (14) Highway 35, from South Motts Parkway thirty-four hundredths
(.34) of a mile southeast to the point where Highway 35 intersects with the overpass for Highway 20/Highway 212, (15) State Road
249 from U.S. 12 to the point where State Road 249 intersects with Nelson Drive at the Port of Indiana, (16) State Road 912 from the
15th Avenue and 169th Street interchange one and six hundredths (1.06) miles north to the U.S. 20 interchange, (17) U.S. 20 from the
State Road 912 interchange three and seventeen hundredths (3.17) miles east to U.S.12, (18) U.S. 6 from the Ohio State line to State
Road 9, (19) U.S. 30 from Allen County/Whitley County Line Road (also know as County Road 800 East) to State Road 9, (20) State
Road 9 from U.S. 30 to U.S. 6, (21) State Road 39 from Interstate 80 to U.S. 20, (22) State Road 3 north from U.S. 6 to U.S. 20, U.S.
20 west from State Road 3 to State Road 9, State Road 9 north from U.S. 20 to the Michigan state line.
No other routes, including detours, are authorized by this permit under any condition.
This permit is valid only for transporting commodities under the company name shown above, and if signed by both an authorized
company owner or offi cer, and driver. The driver’s signature attests to the fact that the description of the vehicle is accurate and un-
derstood by the driver. Under the penalty of perjury, I have examined this permit, and to the best of my knowledge and belief, it is
true, complete and correct. I also understand that all provisions of the Transporting Agreement apply in full force.
__________________________________________________
Driver's Signature
Date
__________________________________________________
__________________________________________________
Company Owner or Responsible Offi cer
Driver's Signature
Date
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