Nm Apportioned Registration Application Schedule Form 2004

New Mexico APPORTIONED REGISTRATION APPLICATION Schedule A NEW ACCOUNT NAME OR ADDRESS CHANGE 1 Company Name RENEWAL INTRASTATE SUPPLEMENT 4 State 3 City 2 Business Street Address 5 Zip Code 7 Date 6 Fax No. SECTION 1 10 Business Mailing Address if different 11 City 12 State 15 TIN Taxpayer Indetification Number 16 US DOT Number Registrant 17 Contact Person 18 Phone No. 20 Is this vehicle running under a lease 21 If 20 is YES list name of owner or owner/operator s 22 If 20 is YES give mailing address 8 Account No. 9 Fleet No. YES NO 14 Registration Yr. 19 Registrant Phone No. VEHICLE INFORMATION ALPHA CODES 1 TRANSACTION TYPE 2 Check if Unit travels A Adding a Vehicle less than 10 000 miles. D Deleting a Vehicle 7 VEHICLE TYPE E Even Exchange CG Converter Gear I Non-IRP B Intrastate NM Base Plate BS Bus DB Double Bottom S Adding a State FT Full Trailer R Renewal TT Truck Trailer W Weight Increase TK Truck P Prorate ST Semi-trailer T R A N S Y P E See ALPHA CODES to Left. Enter US DOT No. of person responsible for vehicle safety. 16 Check If Motor carrier US DOT has changed. 17 Check if the control and responsibility for the safety of this vehicle will be assigned to a different carrier during the registration year. The current NM Title Number. May be obtained from your title or from your local Motor Vehicle Office Vehicle will not be registered without this information. 19 Current NM License Plate Number Indicate the Apportioned license plate number which is currently assigned to the vehicle. BE SURE TO COMPLETE SCHEDULE B BELOW. BC DC IN ME MI NE NJ ND OR SK UT WI AK CA FL IA MB MN NV NM NS PA SC VT WY AB CO GA KS MD MS NF NY OH SD VA YT AZ CT ID KY MA MO NB NT OK QC TN WA AR DE IL LA MX MT NH NC ON RI TX WV Account Number Actual miles reported on Schedule B should be from the 12 month period ending six months prior to the beginning of the registration year. Example Only If you had been applying for a 2004 Apportioned Registration actual miles reported would have been for the period July 1 2002 through June 30 2003. D Deleting a Vehicle 7 VEHICLE TYPE E Even Exchange CG Converter Gear I Non-IRP B Intrastate NM Base Plate BS Bus DB Double Bottom S Adding a State FT Full Trailer R Renewal TT Truck Trailer W Weight Increase TK Truck P Prorate ST Semi-trailer T R A N S Y P E See ALPHA CODES to Left. List only one vehicle per line. Do not duplicate equipment numbers. Continue listing on an additional MVD-11025 form if necessary. Date of A S Unladen Declared Purchase Vehicle Make Owners US DOT Factory See SeeInst. Purchase X Weight Identification F of Price of Unit No. Gross or Inst. L or A Section or Lease U empty Number Combined Mo / Yr Section Section P E Two L New Mexico Title Number Mandatory NM Apportioned Plate Number Taxpayer 10 FUEL G - Gasoline D - Diesel P - Propane 17 TRANSFER Will the control and responsibility for the safety of this vehicle be assigned to a different carrier during the registration year by lease Check if YES. AL WEIGHT INFORMATION If you will operate at a different weight other than what is in column 11 in other states indicate that weight in the corresponding states blocks to the right. Date of A S Unladen Declared Purchase Vehicle Make Owners US DOT Factory See SeeInst. Purchase X Weight Identification F of Price of Unit No. Gross or Inst. L or A Section or Lease U empty Number Combined Mo / Yr Section Section P E Two L New Mexico Title Number Mandatory NM Apportioned Plate Number Taxpayer 10 FUEL G - Gasoline D - Diesel P - Propane 17 TRANSFER Will the control and responsibility for the safety of this vehicle be assigned to a different carrier during the registration year by lease Check if YES. AL WEIGHT INFORMATION If you will operate at a different weight other than what is in column 11 in other states indicate that weight in the corresponding states blocks to the right. BE SURE TO COMPLETE SCHEDULE B BELOW. BC DC IN ME MI NE NJ ND OR SK UT WI AK CA FL IA MB MN NV NM NS PA SC VT WY AB CO GA KS MD MS NF NY OH SD VA YT AZ CT ID KY MA MO NB NT OK QC TN WA AR DE IL LA MX MT NH NC ON RI TX WV Account Number Actual miles reported on Schedule B should be from the 12 month period ending six months prior to the beginning of the registration year.