IOWA INTERNATIONAL REGISTRATION PLAN
VEHICLE SCHEDULE
Form 442015 (08-17)
Office of Vehicle & Motor Carrier Services
P.O. Box 10382
Des Moines, IA 50306-0382
Phone: (515) 237-3268
FAX: (515) 237-3225
Email: [email protected]
Web: iowadot.gov/mvd/omcs
Registrant Name
1
Unit Number
4
Per
Y/N
23
Dealer Name
and Address or
Previous License #
MM/YY of Expiration
and State
22
**
Y/N
21
USDOT No.
Corresponding
Tax ID No.
20
Y/N
19
Transferred
License Plate No.
and Sticker No.
18
1st
Operated
Date
M/D/Y
17
Purchase
Date
M/D/Y
16
Lease
Date
M/D/Y
15
Factory
Price
14
Purchase
Price
13
Weight
Group
Number
12
Gross
Combined
Weight
11
Unladen
Weight
10
Jurisdiction Abbrev.
& Title Number
9
Complete Vehicle
Identification Number
8
Axle
Seats
or
Axles
7
Fuel
6
Make
5
*
Type
3
Year
2
Owner Name
Doing Business as
Second Address Line
AL MALAKYKSINILIDIAGAFLDEDCCTCOCAAZAR
NS SKQCPEON
PA NLNBMBBCABWYWVWIWAVTVAUTTXTNSDSCRI
MD OROKOHNYNVNMNJNHNENDNCMTMSMOMNMIME
Physical Address
Registrant OnlyClient ID Registrant's Phone Number
Fleet Number
FAX Number
License Year
USDOT Number
Tax ID Number
Mailing Address
Second Address Line
Contact Person Name - Regarding Application
City,State, ZIP Code Contact Person Email Address Registrant Email AddressContact Person Phone Number
City,State, ZIP Code
Temporary Evidence of
Apportionment (TEAR) requested?
If you are a Motor Carrier you will need a US DOT Number to enter into the US DOT
Number space.
IA DOT OFFICE USE ONLY
Supp # Date
Reg. Mos. Initials
Registration Month:
No Yes
*If registering a power unit, will you be pulling a trailer? ** Will the control and responsibility for the safety of this vehicle be assigned to a different motor carrier during the registration year?
ADDITIONS
(See Reverse Side For Instructions and Codes.)
No Yes
No Yes
Straight Deletions or Deletions/Transfer of Credit
Unit Number
Complete Vehicle
Identification Number
Deletion Date
MM/DD/YY
Plate Number Reason Removed
Units listed below will be authorized to operate in the jurisdictions and at the weights listed below. List weights in the box for each jurisdiction.
24
Utah
TK
Type
MCO
Replacement cab card $3.00
Duplicate Credential Requests Sticker (includes cab card) $3.50
Plate (includes cab card & sticker) $10.00
Fleet-to-Fleet Transfer
I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the
preceding is true and correct.
Title:
By:
Date:
5S -- Permanent Semi Trailer (5-year billing)
Application Instructions
a. Deletion Only - if you anticipate adding a unit it is recommended you hold your deletion until that time to maximize your transfer credit. If you
do not anticipate an add, please complete a vehicle schedule, and claim for refund reform. Submit these forms along with the vehicle plate
and registration to the Iowa Department of Transportation, Office of Vehicle & Motor Carrier Services, P.O. Box 10382, Des Moines, IA
50306-0382.
b. Deletion and Addition (Transfer of Credit) - when a plate is transferred from a deleted unit to an added unit a vehicle schedule must be completed.
c. Weight increase - complete columns 1, 9, and 12, indicate the desired weight in the jurisdiction box above.
Complete the boxes on the top section of the schedule. The registrant’s information, including name, DBA (if applicable), physical address, city, state, zip
code, the complete mailing address, (if different than the physical address), and registrant’s phone number and email address. The county number is
required for “New Carriers” only. The name and telephone number of the contact person who is responsible for filling out the application must be entered. A
Tax ID number (TIN) must be given, this is either a Federal identification number (FEIN) or a Social Security number (SSN), an FEIN is preferred. If you are
a motor carrier you will need to enter your US DOT Number in the USDOT number space. If you are not a motor carrier, you should check the registrant
only box, (you will not need to enter a USDOT number).
List the desired weights in pounds for each apportioned jurisdiction. Vehicles registered at 55,000 pounds or more must provide current verification of Heavy
Vehicle Use Tax Form 2290. See IRP Manual for acceptable documentation. Documentation can accompany your vehicle schedule or be submitted at time
of payment.
Column 7 Fuel type: D -- Diesel G -- Gas O -- Other
Column 8 Number of axles. Vehicles other than busses should list the number of axles in the top portion. Power units need to list the maximum number of
axles for power unit and trailer in the lower portion. Busses need to list number of seats in the bottom portion.
Column 9 VIN number. A complete vehicle identification number must be used.
Column 10 Title number. Documentation must be provided. See IRP Manual for acceptable documentation. Documentation can accompany your Vehicle
Schedule or be submitted at time of payment.
Column 11 Empty weight.
Column 12 Iowa combined gross weight for which the unit is to be registered.
Column 13 Weight group number for this unit.
Column 14 Purchase price of unit when acquired. (Excluding trade-in and sales tax but including accessories or modifications.)
Column 15 The manufacturer's factory price, excluding trade-in and sales tax, including accessories or modifications attached to the vehicle. If the factory price
is
left blank the system will automatically fill this in using data from the Manufacturer's Suggested Retail Price (MSRP).
Column 16 Lease date - if this vehicle is being leased add month, day and year.
Column 17 Purchase date - month, day and year.
Column 18 Month and year the vehicle was first put in service, (if on the title only list).
Column 19 License plate and sticker number transferred from the deleted unit (if no transfer write None).
Column 20 'Y' if unit travels over 10,000 miles nationally a year. 'N' if unit travels 10,000 miles or less nationally a year (power unit only).
Column 21 USDOT number assigned to vehicle and corresponding Tax Identification Number of the Motor Carrier Responsible for the safety of the vehicle.
See IRP Manual.
Column 22 Will the control and responsibility for the safety of this vehicle be assigned to a different motor carrier during the registration year?
Column 23 Previous license information, plate number, year and state. If newly purchased, give dealer name and address. For any vehicle
which has been stored previous to this licensing you must submit the original storage slip with the vehicle schedule.
Column 24 Top portion: Utah Special Truck Indicator: If your power unit is a: cement pump, well-boring unit, OR crane put a Y; if none of these, leave
blank.
Bottom portion: If your power unit is new put an S (a copy of the Manufacturer's Certificate of Origin (MCO) must be attached to this form);
Otherwise leave blank.
