OREGON WEIGHT RECEIPT AND TAX IDENTIFIER APPLICATIONCONTINUATION SHEET
FORM 735-9076A (10-14)
OREGON DEPARTMENT OF TRANSPORTATIONMOTOR CARRIER TRANSPORTATION DIVISION 3930 FAIRVIEW INDUSTRIAL DRIVE SE SALEM OR 97302-1166 PH (503) 378-6699 FAX (503) 378-6880
ACCOUNT NUMBER SUB BUSINESS NAME EFFECTIVE DATE
OWNED
LEASED
SOLO AXL COMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXL
HUB
KM
REASON FOR APPLICATION
ADD VEHICLE RENEW VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED)
BASE LICENSE NO
LESSOR ODO READING
ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT
FEE BASIS BD
CANCEL VEHICLE
OWNED
LEASED
SOLO AXL COMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXL
HUB
KM
REASON FOR APPLICATION
ADD VEHICLE RENEW VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED)
BASE LICENSE NO
LESSOR ODO READING
ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT
FEE BASIS BD
CANCEL VEHICLE
OWNED
LEASED
SOLO AXL COMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXL
HUB
KM
REASON FOR APPLICATION
ADD VEHICLE RENEW VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED)
BASE LICENSE NO
LESSOR ODO READING
ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT
FEE BASIS BD
CANCEL VEHICLE
OWNED
LEASED
SOLO AXL COMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXL
HUB
KM
REASON FOR APPLICATION
ADD VEHICLE RENEW VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED)
BASE LICENSE NO
LESSOR ODO READING
ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT
FEE BASIS BD
CANCEL VEHICLE
OWNED
LEASED
SOLO AXL COMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXL
HUB
KM
REASON FOR APPLICATION
ADD VEHICLE RENEW VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED)
BASE LICENSE NO
LESSOR ODO READING
ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT
FEE BASIS BD
CANCEL VEHICLE
OWNED
LEASED
SOLO AXL COMB #4 AXLCOMB #3 AXLCOMB #2 AXLCOMB #1 AXL
HUB
KM
REASON FOR APPLICATION
ADD VEHICLE RENEW VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED)
BASE LICENSE NO
LESSOR ODO READING
ST/PROV YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER FUEL UNIT NUMBER VT
FEE BASIS BD
CANCEL VEHICLE
