VI. What is the reason for transfer?
VII. If this application is filed by an administrator, executor, guardian, conservator, assignee, trustee, or
receiver of the person to whom the Certificate or License has been issued, a copy of the appointment
MUST be submitted with this application.
VIII. The Transferor being a holder of a Certificate or License issued by the Transportation Oversight Division
of the Department of Public Utilities under the provisions of Chapter 159A or 159B of the General laws,
as amended and authorized thereby to engage in the carriage of property or passengers by motor
vehicle for compensation upon the ways of the Commonwealth, does hereby request that the approval
and consent of the Department be given to the assignment and transfer in whole or in part, of the
rights, title, and interest of said Transferor in said Certificate or License to the herein proposed
Transferee.
Date:
I hereby certify that the statements contained in this application herein made are full, just and true to
the best of my knowledge and belief. This statement is made under the penalties of perjury.
Signature:
Title:
IX. If Certificate is presently issued to a partnership, signatures of ALL PARTIES are necessary.
Signature: Address:
Signature: Address:
Signature: Address:
X. Pursuant to G.L. c. 62C, § 49A, I certify under the penalties of perjury that I, to my best knowledge and
belief, have filed all state tax returns and paid all state taxes required under law.
Signature of Transferor or type Corporate Name:
Signature of Corporate Officer (if applicable):
Please note: this application has no fee, but a $100 fee is due
from the person or entity purchasing your business.
The Transportation Oversight Division now accepts payments
online. You can also submit a check or money order by mail.
Please see our website for more information:
mass.gov/how-to/pay-transportation-oversight-division-fees
Using Adobe Acrobat or Reader to fill out this application? Click the
red button below to submit your application by email. You can also
save this PDF and submit it as an email attachment to:
DPU.Transportation@mass.gov
You can also print and submit this application by mail to the
Transportation Oversight Division. The Division's mailing address can
be found at the top of this form. Please be sure to pay online or
submit a check/money order with your application.
(Type full, legal name)
(Type full, legal name)
(Type full, legal name)
(Type full, legal name or Corporate Name)
(Type full, legal name)
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