Indiana Department of Revenue
Form M-233T
A. S
D
: J
1, _____
TARTING
ATE
ANUARY
Annual Toll Road Gate Application
State Form 2331
B. E
D
: D
31, ____
XPIRATION
ATE
ECEMBER
(R5/ 11-07)
F
: $20.00
EE
PER GATE
(1) Name of Transporting Company:
(3) Federal Identifi cation Number:
Address:
(4) Social Security Number
(If Sole Proprietor):
City, State, and Zip:
(5) Make of Tractor
Year:
(6) License Plate
State:
Daytime Telephone
Fax Number:
(7) Full Vehicle Identifi cation Number
(VIN):
(8) Toll Road Gate Numbers
(2) Contact Person
A
W
: A single axle must not exceed 22,400 pounds per axle; each axle of a tandem group may not exceed 18,000
LLOWABLE
EIGHTS
pounds per axle; and the weight per inch width of tire measured between fl anges of the rim may not exceed 800 pounds.
A
D
: The category checked below applies to this permitted vehicle and load.
LLOWABLE
IMENSIONS
A single vehicle whose width does not exceed 12 feet, the length does not exceed 65 feet, and the height does not exceed
1
13 feet, 6 inches. The maximum weight, subject to axle limits, may not exceed 90,000 pounds.
2
A combination of two vehicles (tractor-trailer) whose trailer does not exceed 53 feet in length, the width of which does not
exceed 12 feet, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits, may not exceed 90,000
pounds.
A combination of three vehicles (tractor-trailer-trailer) whose trailers do not exceed 48 feet, 6 inches each, the width of which
3
does not exceed 8 feet, 6 inches, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits,
may not exceed 127,400 pounds. C
: You must contact the Indiana Toll Road Authority to obtain a toll road certifi cation
AUTION
for this type of vehicle prior to applying for this permit.
4
A combination of 4 vehicles (tractor and triple trailer) whose trailers do not exceed 28 feet, 6 inches each, the width of which
does not exceed 8 feet, 6 inches, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits,
may not exceed 127,400 pounds. C
: This type of triple trailer combination is not allowed on any highway other
AUTION
than an Indiana toll road, except between an Indiana toll road designated make-up, break-up area and the nearest toll gate.
The General Provisions and any Special Provisions, are incorporated by reference into the permit and are as fully binding upon the per-
mittee as if they had appeared on the face of the permit.
T
P
V
O
S
R
: All state highways, when used in conjunction with toll road travel, within 15 miles to or
HE
ERMIT IS
ALID
VER
TATE
OADS
from the permitted Toll Gate (permits are Gate specifi c), but excluding: all Interstate Highways and Indiana Harbor Canal Lift
Bridges. The permit is NOT valid with a special weight permit.
Special Gate Exceptions
G
101: Excluding any vehicle with an overall length in
ATE
excess of 95 feet.
G
144: Excluding State Road 1 and State Road 427.
ATE
Under penalties of perjury, I declare I have examined the above information, and to the best of my knowledge and belief it
is true, correct and complete.
Signature
Date