MAILTO:POBOX2007,Frankfort,KY40602‐2007

Phone:(502)564‐1257Fax:(502)564‐4138

Drive.Ky.Gov

Applicationfor

NewAuthorityorAdditionalVehicles

ThisformcontainsdocumentsrequiredforapplicationsforDriveawayauthorityandforadditionalvehiclesunderanexistingauthority.Thefollowingsectionsarecontainedinthisapplicationform:

ApplicationIndex

ToApplyforDriveawayAuthority

YouarerequiredtofollowtheseinstructionstocompleteandmailordeliverthisapplicationformincludingtheAuthorityApplication(Section3)andenclosetherequiredfeestotheTransportationCabinet,DepartmentofVehicleRegulation,DivisionofMotorCarriers,QualificationsandPermitsBranch,at200MeroStreet,Frankfort,KY40622.Yourapplicationmaybereturnedforthecorrectionofanydeficiencies.

EncloseaCheckorMoneyOrder

Youmustencloseonecheckormoneyordermadepayabletothe“KentuckyStateTreasurer”intheamountofthe$250applicationfeeplusthepermotorcarriervehiclefeeof$10.($250applicationfee)+(numberofvehicles Xpervehiclefee of$10$ )=totalfees$ .

RegisteryourBusinessorBusinessName

BusinessOrganizationsMustRegisterwiththeKentuckySecretaryofState

IfyouareabusinessorganizationthatisrequiredtoberegisteredwiththeKentuckySecretaryofStateinordertodobusinessinKentucky,youshallcompleteyourregistrationasadomesticorforeignbusinessorganization priortosubmittingthisapplication.Ifyou have any questionsregardingtheregistrationprocesspleasecontactyourattorneyortheofficeoftheKentuckySecretaryofState.

SoleProprietorsMustFileaCertificateofAssumedNamewiththeCountyClerk

IfyouareoperatingyourbusinessasasoleproprietoryouarenotrequiredtoandmaynotregisteryourbusinessnamedirectlywiththeKentuckySecretaryofState,butyouarerequiredtofileacertificateofassumedname withthecountyclerkwhereyoumaintainyourprincipal placeofbusiness.CompleteandrecordtheenclosedCertificateofAssumedNameforSoleProprietor(Section

3)thenenclosetherecordedcopywiththisapplication.

QualificationofVehicles

Vehicles10,001lbs.orgreater,requireaUSDOTnumber.Youmayvisit

ApplyingtoQualifyAdditionalVehiclesunderanExistingAuthority

Youmayusethisapplicationformtoqualifyadditionalvehiclesasanamendmenttoanexistingauthority.IfusingthisapplicationtorequesttheauthoritytoqualifyadditionalvehiclesyoushallagainsubmittheAuthorityApplication(Section3)andencloseacheckormoneyordermadepayabletothe“KentuckyStateTreasurer”inanamountequalto$10perqualifiedvehiclefee.The$250applicationfeeisnotrequiredtoapplyforadditionalvehicles.

AuthorityandQualifiedVehicleCredentials

Foryoursecurity,iftheDepartmentofVehicleRegulationapprovesyourapplicationfornewauthorityorforadditionalqualifiedvehicles,theauthorityandvehiclecredentialsissuedbythedepartmentwillbemailedbyfirstclassmailtoyourmailingaddressonfilewiththedepartment.Alternatively,thecredentialsmaybedeliveredinpersontoeitheraSoleProprietororanauthorizedofficerorregisteredagentoftheCorporation,Partnership,orLimitedLiabilityCompanylistedwiththeKentuckySecretaryofStatewhoseidentitycanbereadilyverified.Youmayrequestovernightorotherexpeditedmaildeliverybysubmittingwiththisapplicationacorrespondingprepaidenvelopeaddressedtoyourmailingaddressonfile.

ApplicationProcessAssistance

Ifyou havequestionsaboutthis applicationformortheapplicationprocess,pleasecontact theDepartmentofVehicleRegulation,DivisionofMotorCarriers,QualificationsandPermitsBranch,byphoneat(502)564‐.

PursuanttotheprovisionsofKRS365.015,theundersignedappliestoassumeanameand,forthatpurpose,submitsthefollowingstatement:

1.Theassumednameis:

2.Thelegalnameoftheindividualadoptingtheassumednameis:

3.Thestreetaddressis:

City / County / State / ZIP
4. Themailingaddressis:
City / County / State / ZIP

IdeclareunderpenaltyofperjuryunderthelawsofKentuckythattheforegoingistrueandcorrect.

Signature

PrintnameDate

STATEOF

COUNTYOF

Subscribedandsworntobeforemeonthistheday of

20 .

NotaryPublic

Mycommissionexpireson.

Anassumedname shallbe effectivefor a termof five (5)years from thedate offiling andmay berenewed forsuccessivetermsuponfilingarenewalcertificatewithinsix(6)monthspriortotheexpirationoftheterm,inthesamemanneroffilingtheoriginalcertificateofassumedname.

Qualificationyear20

Companyno.

USDOT number Legalname Doingbusiness as Mailingstreet address City County State Zip Phone Fax

Emailaddress(required)

Numberofvehicles
Pervehiclefee / X$10.00
Applicationfee / +$250.00 / (Newauthorityonly)
Totalfees

SignatureDate

PrintnamePrinttitle

38Applicationand
VehicleFee

(Departmentuse)