1
MISSOURI DEPARTMENT OF TRANSPORTATION
EMAIL:
contactmcs@modot.mo.gov
MOTOR CARRIER SERVICES
PHONE:
866.831.6277
PO BOX 270, 830 MODOT DRIVE, JEFFERSON CITY, MO 65102-0270
FAX:
573.522.6708
FORM HML1 APPLICATION FOR HOUSEMOVER LICENSE
IT IS STRONGLY RECOMMENDED THAT YOU USE THE INSTRUCTIONS PROVIDED WITH THIS FORM AS A GUIDE.
INCOMPLETE OR INCORRECT APPLICATIONS WILL DELAY THE ISSUANCE OF AUTHORITY.
SECTION 1. GENERAL INFORMATION
USDOT NO.
FEIN NO
SOCIAL SECURITY NO. (If sole owner)
LEGAL NAME
DOING BUSINESS AS (DBA) NAME
PRINCIPAL PLACE OF BUSINESS ADDRESS (Not a PO Box)
STREET
STATE
ZIP CODE
MAILING ADDRESS (if different from principal address)
STREET
STATE
ZIP CODE
DAYTIME PHONE NO.
FAX NO.
E-MAIL ADDRESS
SECTION 2. FORM OF BUSINESS
Sole Proprietorship Partnership Limited Partnership (LP) Limited Liability Limited Partnership (LLP)
Corporation Limited Liability Company (LLC) Trust
STATE OF ORGANIZATION/INCORPORATION DATE ORGANIZED CHARTER NO
NAME OF COMPANY OFFICERS/PARTNERS (not required for sole proprietor) PLEASE PRINT
TITLE
SECTION 3. TYPE OF APPLICATION (check only one)
NEW HOUSEMOVER LICENSE Applicant has not previously applied for a Housemover License.
RENEWAL HOUSEMOVER LICENSE Applicant is renewing a Housemover License.
SECTION 4. TYPE OF OPERATION (check any that apply)
Transporting houses wholly within commercial zones in the state of Missouri as defined under section 390.020, RSMo or otherwise
exempt under section 390.030, RSMo.
Transporting houses on public roads and highways of this state but not limited as described above.
SECTION 5. HOUSEMOVER QUALIFICATIONS (answer all questions)
YES NO Applicant is at least eighteen years of age.
YES NO Applicant possesses a valid commercial driver’s license.
YES NO Applicant has at least twenty-four months experience in moving houses.
SECTION 6. WORKERS’ COMPENSATION (check only one)
Applicant is certified as self-insured by the Missouri Division of Workers’ Compensation.
Applicant has coverage in place to comply with the workers’ compensation insurance requirements in chapter 287, RSMo for all
employees.
SECTION 7. PUBLIC LIABILITY SECURITY & CARGO INSURANCE
Applicant is required to file proof of insurance to the limits of liability prior to issuance of license (see instructions for requirements).
CONTACT YOUR INSURANCE COMPANY TO FILE THE REQUIRED INSURANCE FORM(S) WITH MODOT.
SECTION 8. ANNUAL LICENSE FEES
Applicant’s payment of the required annual license fee of $100 must be received prior to issuance of license.
SECTION 9. VEHICLE LISTING & PROOF OF VEHICLE INSPECTION
Applicant must attach a list of all vehicles used in the movement of houses using the attached HML-2 Form.
The vehicles on this list must meet the requirements of sections 307.350 to 307.400, RSMo or its equivalent pertaining to the inspection
of motor vehicles.
SECTION 10. CERTIFICATION
Under penalty of perjury under the laws of the State of Missouri and the United States of America, the information in this application or
attached hereto is true and correct, I am authorized to sign this application on behalf of the applicant and the signature below is my own
true and correct signature made by me or my legal representative and by no other person.
Applicant Name Printed
Title
Applicant Signature
Date
2
MISSOURI DEPARTMENT OF TRANSPORTATION
EMAIL:
contactmcs@modot.mo.gov
MOTOR CARRIER SERVICES
PHONE:
866.831.6277
PO BOX 270, 830 MODOT DRIVE, JEFFERSON CITY, MO 65102-0270
FAX:
573.522.6708
FORM HML2 VEHICLE LISTING & PROOF OF INSPECTION
FOR HOUSEMOVERS LICENSE
THIS FORM MUST BE UDPATED AND FILED WITH MODOT MOTOR CARRIER SERVICES IF ANY CHANGE
OCCURS IN THE VEHICLES USED IN OPERATION DURING THE LICENSE YEAR.
GENERAL INFORMATION
LEGAL NAME
USDOT NO
FEIN NO/SSN NO
DOING BUSINESS AS (DBA) NAME
PHONE NO
FAX NO
LIST OF EQUIPMENT TO BE USED
MAKE
MODELYEAR
VIN NUMBER
LICENSE NUMBER
ANNUAL VEHICLE
INSPECTION
(Check if annual vehicle
inspection was performed
within one year of this
application)
Attach list if needed for additional equipment.
CERTIFICATION
Under penalty of perjury under the laws of the State of Missouri and the United States of America, the information in this application or
attached hereto is true and correct, I am authorized to sign this application on behalf of the applicant and the signature below is my own
true and correct signature made by me or my legal representative and by no other person.
Applicant Name Printed
Title
Applicant Signature
Date
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