Form Mcs-66 - Add And/or Delete Vehicle(S) For Kansas Registration And Change In Equivalent Weights In Other Irp Jurisdictions

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KS IRP Schedule C
Add Unit(s)
Fleet to Fleet Transfer
STATE OF KANSAS
Weight Increase
Correction
Motor Carrier Services Bureau
Account #_______________________
Transfer Vehicle
Add Jurisdiction
Phone 785-296-6541
Fleet #_________________________
Pick One From List Above
Fax 785-296-6548
Request Temporary Credential
Fax Temporary Credential to:
Supplement #____________________
NAME ON ACCOUNT
FLEET NUMBER
USDOT NUMBER
DOING BUSINESS AS (D/B/A)
TAXPAYER IDENTIFICATION NUMBER (TIN) or (EIN)
REGISTRANT ONLY?
YES
NO
PHYSICAL ADDRESS
CONTACT PERSON
MC NUMBER
MAILING ADDRESS
TELEPHONE NUMBER
CELL PHONE NUMBER
REGISTRATION YEAR
(
)
(
)
MARK JURISDICTIONS TO ADD OR IF NEEDED ENTER VARIANT JURISDICTIONAL WEIGHTS - If Registered at Kansas Weight 85,500
AB
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
VEHICLE INFORMATION
BUS
VEHICLE IDENTIFICATION NUMBER
*TYPE
GROSS WEIGHT
UNLADEN WEIGHT
COLOR OF VEHICLE
UNIT NUMBER MODEL YEAR
MAKE
AXLES
**FUEL
SEATS
*TYPE
TT (tractor)
TK (truck)
1
ST (trailer)
TRANSFER VEHICLE INFORMATION
REGISTRANT ONLY - CARRIER RESPONSIBLE FOR VEHICLE SAFETY
BS (bus)
ORIGINAL
A copy of the lease agreement with the Carrier Responsible for Safety
ORIGINAL PURCHASE DATE
TRANSFER UNIT
PURCHASE
must accompany this form, unless the Carrier Responsible for Safety
LEASE DATE
TRANSFER PLATE
TRANSFER REASON
REQUIRED
NUMBER
PRICE
will change within the next 30 days.
REQUIRED
Completed Non Motor
YES
NO
Carrier Declaration Form
**FUEL
D
G
BUS
P
UNIT NUMBER MODEL YEAR
MAKE
VEHICLE IDENTIFICATION NUMBER
*TYPE
AXLES
**FUEL
GROSS WEIGHT
UNLADEN WEIGHT
COLOR OF VEHICLE
SEATS
2
TRANSFER VEHICLE INFORMATION
REGISTRANT ONLY - CARRIER RESPONSIBLE FOR VEHICLE SAFETY
ORIGINAL
A copy of the lease agreement with the Carrier Responsible for Safety
ORIGINAL PURCHASE DATE
TRANSFER UNIT
PURCHASE
LEASE DATE
TRANSFER PLATE
TRANSFER REASON
must accompany this form, unless the Carrier Responsible for Safety
REQUIRED
NUMBER
PRICE
will change within the next 30 days.
REQUIRED
Completed Non Motor
YES
NO
Carrier Declaration Form
The undersigned certifies that the information furnished in this application and any supporting documents are true and correct.
Date
Signature
Title
MCS-66 (4/11

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