Form 703 - Application For Emergency Or Temporary Authority - To Transport Passenger Or Household Goods Page 5
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5Instructions for Application of Common or Contract Emergency
Temporary Authority or Temporary Authority
Please read these instructions carefully before completing the application.
Defi nitions:
Common Carrier
-
A person holding itself out to the general public to provide motor
vehicle transportation for compensation.
Contract Carrier
-
A person, providing motor vehicle transportation for compensation
under continuing contract(s) for named shipper(s).
Certifi cate
-
The document issued by the Department to a Common Carrier.
Permit
-
The document issued by the Department to a Contract Carrier.
The application for emergency temporary or temporary authority must be typewritten or legible. The original and one
copy of the application must be fi led.
Each line of the application must be completed. If a line is not applicable to you or your operation, you should enter “N/A”
in the space provided for the answer.
45 IAC 16-1.5-3 Any person may appear and represent his or her own interest before the commission. The interest of
another person or entity shall be represented only by an attorney authorized to practice before the commission, pursuant
to this section.
In order for the application to be processed by the Department, you must include the following with your application:
1. A fi ling fee of $100; make checks payable to the Indiana Department of Revenue;
2. Two copies of a tariff (if you are seeking authority to operate as a common carrier); or
Two copies of a schedule of minimum rates and a copy of each proposed signed contract, or a copy of the signed
contract with rates attached (if you are seeking authority to operate as a contract carrier);
3. Proof of insurance as required by IC 8-2.1-22-46 and 45 IAC 16-1-2. Your insurance company must fi le a Form E
with the Indiana Department of Revenue which indicates the amount of coverage.
4. A certifi cate from the Secretary of State of Indiana showing that you are registered to do business in Indiana (if
your company is a non-resident corporation); or
A certifi cate of existence from the Secretary of State of Indiana (if your company is an Indiana corporation); and
5. Affi davits from members of the shipping public which establish that an emergency and/or immediate need exists
for the proposed service.
6. A statement describing applicant’s fi nancial status, including a brief statement of assets and liabilities as of the
date of application, and a copy of applicant’s most recent balance sheet and income statement.
If you have any questions regarding this application, please contact the Department at:
Indiana Department of Revenue
Motor Carrier Services
Insurance and Safety Unit
7811 Milhouse Road Suite M
Indianapolis, Indiana 46241-9612
or call (317) 615-7295
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