Form Reg-3-Mc - Application For Motor Carrier Road Tax - 2013 Page 2
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2REG-3-MC
Instructions
Complete this application blue or black ink only.
Line 4.
Print the physical location of the business. PO boxes
are not acceptable. Indicate where the business is
Complete form REG-3-MC, Application for Motor Carrier Road
actually located.
Tax, to apply for calendar year 2013 motor carrier decals. Two
Line 5.
Print the mailing address of the business if different from
numbered decals will be issued for each qualifi ed motor
Line 4. Only complete this if different from the
vehicle. One decal must be placed on the lower rear exterior
business address listed above.
of the passenger side cab door and the matching decal must
be placed on the lower rear exterior of the driver side cab door
Line 6.
Print the name and home address of proprietor,
for each vehicle.
partner, LLC member, or corporate offi cer. Identify the
proprietor if a sole proprietorship; partners if a
Qualifi ed motor vehicles subject to the Connecticut motor
partnership; or offi cers if a corporation.
carrier road tax are those used, designed, or maintained for
transportation of persons or property and:
Line 7.
Print the home address of partner, LLC member, or
corporate offi cer.
•
Have two axles and a gross vehicle weight or registered
gross vehicle weight exceeding 26,000 pounds or 11,797
Line 8.
Indicate the type of business and enter its Federal
kilograms;
Employer Identifi cation Number (FEIN) in the spaces
provided on Line 2. If it is a sole proprietorship with
•
Have three or more axles regardless of weight; or
no employees and is not required to have a FEIN,
•
Are used in combination and the combined gross vehicle
enter the proprietor’s Social Security Number (SSN)
weight or registered gross vehicle weight exceeds 26,000
in the spaces provided on Line 6 and Line 7. If Other,
pounds or 11,797 kilograms.
attach an explanation.
For Connecticut motor carrier road tax purposes, the term
Line 8a. Enter the name of the state under the laws of which
qualifi ed motor vehicle does not include recreational vehicles
the business is organized.
not used in connection with any trade or business.
Line 9.
Indicate whether you are registered with DRS. If you
Do not use this motor carrier road tax application to request
checked Yes on Line 9, enter your Connecticut Tax
International Fuel Tax Agreement (IFTA) decals. To request IFTA
Registration Number in the space provided in the
decals, complete CT-IFTA-2, Application for International Fuel
upper right hand corner of this form.
Tax Agreement (IFTA) License Connecticut Carrier.
Line 10. Provide details of your business operations.
Instructions
Line 11. Provide the names and addresses of the lessors you
lease vehicles from.
Line 1.
Indicate new account, registration of additional
vehicles, or other reason (renewal, replacement
Line 12. Indicate the number of qualified motor vehicles
decals, or change of ownership). If there has been
requiring decals and multiply by $10. Enter the
any change of identity or form of ownership or
amount due.
organization, such as the addition of a new partner
This application must be signed by an owner, partner, corporate
or the incorporation of the business, you must use
offi cer, or LLC member.
form REG-3-MC to apply for a new Connecticut Tax
Registration Number. If you are registered with the
Failure to complete all items on this application may result in a
Connecticut Department of Revenue Services (DRS),
delay in processing your application.
enter your Connecticut Tax Registration Number in
Make check payable to Commissioner of Revenue Services.
the upper right corner of this form.
DRS may submit your check to your bank electronically.
Line 2.
Print the name of the owner, partnership, limited
Do not send cash. Return the completed application with full
liability company (LLC), or corporate name. Enter
payment.
proprietor’s name if a sole proprietorship.
Mail to: Department of Revenue Services
Line 3.
Print the trade or registered name if different from
Registration Section
Line 2. A trade or registered name is the name
PO Box 2937
under which business is done, but not necessarily
Hartford CT 06104-2937
the owner’s name. Example: If John Travel is the
If you need assistance or additional information about
proprietorship entered on Line 2, but John T. Trucker
applications or
registering your vehicle(s), call DRS Registration
Co. is the name chosen by John Travel for his
Section at 860-297-4870, Monday through Friday, 8:30 a.m.
business, then John T. Trucker Co. is the name he
to 4:30 p.m.
would enter on Line 3.
REG-3-MC Back
(Rev. 11/12)
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