Free TC-852, IRP Original and Supplemental Application - Utah

Clear form
IRP Original (Schedule A) and Supplemental (Schedule C) Application
Registrant fleet account number Fleet number U.S. DOT number D.B.A., if any License year

TC-852 Rev. 12/08
Application effective date

UTFederal ID (FEIN/EIN) Name of registrant Utah IFTA account number Registrant phone no. (must be a Utah number) Person to contact regarding application Contact's city Contact's phone no. ZIP code Contact's fax no.
Contact's state

Registrant street address (where records are kept - must be a Utah physical address) City County State ZIP code

UT
Fleet (situs) permanent address (if different than registrant above) City Mailing address City Registration period (check one) MAR 31 JUN 30 SEPT 30 DEC 31 State ZIP code Exempt Is this an organization exempt from property tax? Yes No Household goods Do you currently have Wyoming intrastate operating authority? Yes No County State If previously prorated in another state provide previous state and account number State: Account no.: Type of operation (check the ONE that applies) For hire Private only if rental Rental is less than 45 days

UT

Registered Weights List below only the units that will operate at the same weight in the IRP jurisdictions. If traveling in Quebec, list the total combined axles for power units/trailers and the gross weight for buses.
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA

Weight group # Type (B-Bus P-Power T-Trailer) WI WV WY AB BC MB NB NF NS NT PE ON QC SK YT MX

Equipment Information
Action codes: A - Add vehicle R - Renew vehicle W - Weight change C - Change vehicle (may not add units on a renewal) Fuel Key: D-Diesel G-Gasoline GH-Gasohol N-Natural P-Propane F-Flex fuel Type key: BS-Bus C-Cement Pumper CG-Converter Gear CR-Crane DB-Double Bottoms DT-Dump Truck LG-Log Truck RT-Road Tractor TK-Truck (single) TL-Full-Trailer or Semi-Trailer TR - Tractor TT-Truck/Tractor W-Wellborer WK-Wrecker/Tow Truck Action code Make Fuel Year Type For Office Use Only Do not FT Equipment number Vehicle identification number renew 1 Yr. Pro. tax _______ Unladen weight Decl. comb. gross Axles/Seats Name of titled owner/lessor 2 Yr. Pro. tax _______ wgt Situs of vehicle (physical location of vehicle if different than fleet) City County State ZIP code Select plate type LE Skier LE Arches HVUT verified _______ I/M # verified _________ Inspec # verified _________ Title verified ___________ Factory price ____________ Sales tax Y/N _______ Curr. veh. value___________

Owned/Leased Lease start date Lease end date FEIN/EIN of carrier responsible for vehicle safety US DOT number Vehicle safety changed? Yes No Truck pull trailer? Less than 10K/miles Plate Title Temp. License plate number Yes No Purchase date Purchase price

Continue equipment information on next page

Registrant account number

UTFleet number

Equipment Information - continued
Action code Do not FT Equipment number renew Vehicle identification number Type Make Year Fuel For Office Use Only 1 Yr. Pro. tax _______ 2 Yr. Pro. tax _______ HVUT verified _______ I/M # verified _________ City County State ZIP code Select plate type LE Skier LE Arches Inspec # verified _________ Title verified ___________ Factory price ____________ Sales tax Y/N _______ Curr. veh. value___________ Year Fuel For Office Use Only 1 Yr. Pro. tax _______ Unladen weight Decl. comb. gross wgt 2 Yr. Pro. tax _______ HVUT verified _______ I/M # verified _________ City County State ZIP code Select plate type LE Skier LE Arches Inspec # verified _________ Title verified ___________ Factory price ____________ Sales tax Y/N _______ Curr. veh. value___________ Year Fuel For Office Use Only 1 Yr. Pro. tax _______ Unladen weight Decl. comb. gross wgt 2 Yr. Pro. tax _______ HVUT verified _______ I/M # verified _________ City County State ZIP code Select plate type LE Skier LE Arches Inspec # verified _________ Title verified ___________ Factory price ____________ Sales tax Y/N _______ Curr. veh. value___________

Axles/Seats Name of titled owner/lessor Situs of vehicle (physical location of vehicle if different than fleet

Unladen weight

Decl. comb. gross wgt

Owned/Leased Lease start date Lease end date FEIN/EIN of carrier responsible for vehicle safety US DOT number Vehicle safety changed? Yes No Truck pull trailer? Less than 10K/miles Plate Title Temp. License plate number Yes No Action code Do not FT Equipment number renew Vehicle identification number Purchase date Type Purchase price Make

Axles/Seats Name of titled owner/lessor Situs of vehicle (physical location of vehicle if different than fleet

Owned/Leased Lease start date Lease end date FEIN/EIN of carrier responsible for vehicle safety US DOT number Vehicle safety changed? Yes No Truck pull trailer? Less than 10K/miles Plate Title Temp. License plate number Yes No Action code Do not FT Equipment number renew Vehicle identification number Purchase date Type Purchase price Make

Axles/Seats Name of titled owner/lessor Situs of vehicle (physical location of vehicle if different than fleet

Owned/Leased Lease start date Lease end date FEIN/EIN of carrier responsible for vehicle safety US DOT number Vehicle safety changed? Yes No Truck pull trailer? Less than 10K/miles Plate Title Temp. License plate number Yes No Purchase date Purchase price

Deletions The original cab card and license plate must be surrendered on all deleted units within 10 business days in order to transfer fee
Equipment number Equipment number Equipment number Plate Plate Plate Vehicle identification number Vehicle identification number Vehicle identification number Equipment number Equipment number Equipment number Plate Plate Plate Vehicle identification number Vehicle identification number Vehicle identification number

The State has in effect a requirement that registrants of Commercial Motor Vehicles (CMV) declare their knowledge of the applicable Federal and State CMV safety laws and regulations. For more information, contact Utah Department of Transportation (UDOT) at 801-965-4000 or go to their website at udot.utah.gov. My signature below acknowledges that I understand and will comply with the reporting, payment, record keeping, and license display requirements as specified in the International Registration Plan. I understand that failure to comply with the provisions shall be grounds for revocation of my registrations in all member jurisdictions. I have reviewed and verified all information for accuracy and all corrections have been made. Under penalty of law, I certify, under the penalties of perjury, that the information herein is true, correct, and complete.
Signature of person completing application Date signed

Instructions For IRP Original (Schedule A) and Supplemental (Schedule C) Application This form is to be used to add a new account, add and or delete vehicle(s) for Utah registration, to change ownership of vehicle(s) on an existing fleet, and for change in equivalent weights to other IRP Jurisdictions. All vehicles are to be categorized by the combined gross weight in the same equivalent weight for all jurisdictions and submitted on separate pages according to the different weights. FEIN/EIN: Federal Identification Number (can not be a Social Security Number). Name of Registrant: Full name of registrant. Fleet/Situs: Physical address of Fleet. Contact person and Phone number: Individual's name and telephone number that is responsible for answering any questions regarding the application. Registrant Fleet Account Number: Seven character account number assigned by Utah Motor Carrier Services. Type of Operation: Check one that applies to the type of operation that you have. Fleet: The fleet number you want the Vehicle(s) placed on. Registration Period: Check a registration period you would like the fleet to expire in. Weight Group number: List the weight group number for the weight group you would like the vehicles placed in. Registered Weights: List the weights for the jurisdictions you want listed on your cab card. Action Code: A- Add vehicle, R- Renew vehicle, W- Weight change, C-Change vehicle (owner change). FT Equipment Number: Unit number assigned to the vehicle. Year: The model year the vehicle was manufactured. Use a 2-digit year (example "06"). Make: The first four characters of the vehicle manufacture (example "Dodg"). Vehicle Identification number: Complete all the letters and numbers used to identify the vehicle (VIN). Type: Show the type based on description of the "Type key." Axle/Seats: Show number of axles under each vehicle listed or show number of passengers for a Bus. Fuel: Show type of fuel vehicle uses based on "Fuel Key." Unladen Weight: The actual weight of the vehicle, excluding the weight of the load. Declared Combined Gross Weight: The declared gross vehicle weight, including the load. Purchase Date: The date the vehicle was purchased. Name of Titled Owner/Lessor: Who is to be listed on the title as the vehicle owner. Fein/Ein: Enter the Federal Employer Identification number of the person(s) responsible for the safety of the vehicle. USDOT: Enter the USDOT number for the person(s) responsible for the safety of the vehicle. Vehicle Safety Change: Will the USDOT and EIN of the person(s) responsible for the safety of the vehicle change during the registration period? Less than 10K/Miles: Does the vehicle run less than 10,000 miles annually (individual vehicle miles)? License Plate Number: Enter the Utah plate number if previously registered in Utah. Proof of Payment of Federal Heavy Vehicle Use Tax There is a requirement that the Internal Revenue Service (IRS) form 2290-Schedule 1, "Schedule of Heavy Highway Vehicles" must be submitted for all power units with a registered weight over 54,000 lbs GVW. Return the most current stamped copy of Schedule 1 (applicable year). Copies of the form 2290 may be obtained at www.irs.gov or from a local IRS office. The IRS has four locations in Utah for filing and obtaining these forms. Salt Lake Office, 50 S 200 E, SLC, UT 84111; Utah State Tax Commission, 210 N 1950 W, SLC UT 84134; Ogden Office, Federal Building, 25th Washington Blvd., Ogden, UT 84401; Provo Office, 173 E 100 N, Provo UT 84606; Office hours for all locations 8:30 am - 4:30 PM. Safety Inspection and Emission Certificate (if required) Safety inspection certificates for vehicle with a registered weight of less than 26,000 lbs must be dated within the previous two months. Fleets of 101 vehicles or more, the certificate for safety must be dated within the previous 11 months. Emissions certificates must be dated within the previous 11 months. Refer to website at http://motorcarrier.utah.gov. MCS 150 Form MCS 150 included with this renewal packet must be completed and returned with this renewal. Form MCS 150 must be completed annually to update the U.S. DOT number census information. Please find attached additional notes for hazardous materials carriers who are required to submit a MCS 150-B instead of the standard MCS 150.

New Account or Fleet Change Vehicle Owner or Currently Registered IRP Vehicle Renew Existing Fleet


FEIN/EIN is required (can not use SSN) Have established place of business in Utah - Established place of business means a physical structure owned, leased or rented by the fleet registrant. - Street address in Utah. - Open during business hours and have one or more persons employed on a permanent basis for trucking related business. - Operational records maintained. Performance Registration Information Systems Management. - Must have a US DOT number associated with each fleet registrant and power unit. - MCS 150 must be updated annually. Have you registered with Dept. of Commerce? Complete TC-69MC. Complete IRP application, TC-852. Complete IRP, TC-899B (original mileage sch.). To title an IRP vehicle. - Complete Application for Utah Title, TC-656. - Submit original title or MSO. - Out of state title or MSO must have VIN inspection. - Complete sales tax affidavit Form TC-719 if above 26,000 lb. To Register Only an IRP Vehicle - Complete Application for Utah Title, TC-656 marked "registration only" across top. - Copy of front and back of current title or current registration. - Out of state title or registration must have VIN inspection. Lease agreement if vehicle is not owned by registrant. Safety inspection required if vehicle is registered under 26,000 lb. Emissions for vehicles in emissions counties. - MSO, no safety or emissions required. IRS form 2290 for vehicles registered at 55,000 lbs or over.



Have established place of business in Utah. - Established place of business means a Complete IRP application, TC-852. Complete IRP application, TC-852 physical structure owned, leased or rented by Complete application for Utah Title, TC-656. To title IRP vehicles. the fleet registrant. Submit original title. - Complete application for Utah title, TC-656. - Street address in Utah. - Out of state title must have VIN inspection. - Submit original title or MSO. - Open during business hours and have one or Complete TC-719 Sales tax affidavit. - Out of state title or MSO must have VIN more persons employed on permanent basis Lease agreement if vehicle not owned by inspection. for trucking related business. registrant. - Complete sales tax affidavit form TC-719 if - Operational records maintained. above 26,000 lb. Review and verify all information on preprinted To register only an IRP vehicle. renewal packet that was mailed to you. - Complete Application for Utah Title, TC-656 Add Jurisdiction - Verify FEIN, DOT #, VIN, Unit #, owner's name, marked "registrant only" across top. Complete IRP application, TC-899B original purchase price, vehicle value and weight group - Copy of front and back of current title or mileage schedule for each unit on Schedule A. current registration. Delete units not being renewed. - Out of state title or registration must have VIN Complete IRP application, TC-852 listing weights for new jurisdiction and units. Enter total fleet miles from reporting period on inspection. - Submit separate application if jurisdiction have original mileage Schedule B. Lease agreement if vehicle not owned by more than one weight group and list units. - Enter a "Y" for yes or "N" for no for each registrant. jurisdiction apportioned or not apportioned. Safety inspection if vehicle is registered under - Enter "A" actual miles or "E" estimated miles. 26,000 lb. - Enter detailed explanation for estimated miles. Weight Group Change Emissions for vehicles in emissions counties. Performance Registration Information Systems Mgt. - MSO, no safety or emissions required. Complete IRP application, TC-852 - Must have a US DOT number associated with IRS form 2290 for vehicles registered at List new weights for each jurisdiction in boxes each fleet and power unit 55,000 lbs or over. and units included in that weight group. - Submit (preprinted) MCS - 150. Deleted vehicles must surrender cab card and - Submit separate application for each new - MCS - 150 data must be updated annually. plates within 10 business days to transfer fees. weight group. Submit emissions for vehicles in emission counties. Submit safety inspections for vehicles registered Replace Cab Card under 26,000 lbs. Submit IRP application TC-852 with the unit Submit IRS form 2290 (HVUT) showing received information. by IRS for vehicles registered at 55,000 lb or more. Sign and date renewal paperwork and return to Motor Carrier Services. Corrections must be made prior to final Replace Plate payment. Submit IRP application TC-852 with unit After submitting your payment and required information. documents, allow 7 to 10 business days for Check plate field. processing. It will not be possible to wait for renewal credentials at the counter. Documents are processed in the order they are received.

Adding Vehicles to Existing Fleet And Deleting Vehicle, Transfer Fees

Fleet to Fleet Transfer

Complete IRP application, TC-852 for vehicle to be added (list fleet vehicle has moved from) Lease agreement if leased vehicle Original cab card