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WT-1 FORM INSTRUCTIONS
If you have a permit to transport waste tires and need to add or replace power units fill out a WT-2 – Supplemental Permit Certificate for
Transporting Waste Tires form.
SECTION 2 – GENERAL INFORMATION
USDOT Number – A USDOT number is required to transport waste tires in the state of Missouri. A USDOT number can be obtained at
www.fmcsa.dot.gov/registration.
FEIN Number/Social Security Number – An FEIN number is a federal Tax ID number. A sole proprietor who does not have an FEIN number should
enter a Social Security Number.
Name of Carrier – This is the Company name or Legal Name registered with the Missouri Secretary of State. This name MUST be the same as the
name registered with the FMCSA and the Missouri Secretary of State’s Office, if applicable. All Limited Partnerships, Corporations and Limited
Liability Companies must register with the Missouri Secretary of State u nless the principal place of business is outside of the state of Missouri and
the company participates in interstate commerce as defined in section 390.020, RSMo. Legal name registrations can be filed on line at
www.sos.mo.gov or by calling 1.866.223.6535.
Doing Business As (DBA) Name – A DBA is a name that a company may use that is different from their legal company name. If using a DBA name, it
MUST be registered with the Missouri Secretary of State unless the principa l place of business is outside of the state of Missouri and the company
participates in interstate commerce as defined in section 390.020, RSMo. Fictitious name registrations can be filed online at www.sos.mo.gov or by
calling 1.866.223.6535.
Principle Place of Business – The Principle Place of Business address is the location where the safety records of the company are kept or can be
made available. This must be a physical location, not a PO Box.
Mailing Address – Enter the mailing address if different than the principal place of business address. This address may be a PO box.
Missouri Terminal Address – List the address of any terminal located in the state of Missouri, if applicable.
SECTION 2 – REGISTERED AGENT FOR SERVICE OF PROCESS IN MISSOURI
If the principal place of business is NOT in Missouri the name and address of a process agent based in Missouri where service can be made on the
business MUST be provided. This must be the name of an individual, not an organization, and the address must be a physical location, not a PO Box.
The FMCSA provides a list of some process agents on their website at www.fmcsa.dot.gov/registration/process-agents.
SECTION 3 – FORM OF BUSINESS
A. BUSINESS TYPE – Check the box that represents the type of business. This MUST be the same as the type of business registered with the
Missouri Secretary of State, if applicable. Enter the company date of incorporation, state of incorporation, and state registration number.
B. CERTIFICATE OF GOOD STANDING – Indicate if the company is in good standing with the registration state. If not required to register with the
Missouri Secretary of State, a certificate of good standing from the registration state MUST be provided. Partnerships must provide a copy of the
partnership agreement (new license only).
C. COMPANY OFFICERS – List the company’s officers, partners, or members and their titles. This is not required for sole proprietors.
SECTION 4 – AREA TO BE SERVED
INTERSTATE – Check this box if you travel through Missouri when transporting waste tires.
INTRASTATE – Check this box if you do business within the state of Missouri as part of transporting waste tires.
SECTION
5 – WASTE TIRE MOVEMENTS
A. List the approximate number or weight of waste tires transported per month.
B. Select if the company has ever been in violation of section 260.270 through 260.278 RSMo. Answering Yes to this question WILL NOT result in
denial of a waste tire permit. If you an swer No to this question and it is determined that the company has been in violation the application
WILL be denied. More information about these sections can be found at http://revisor.mo.gov/main/OneChapter.aspx?chapter=260.
C. Provide a list of all drivers, along with their license number and state for all haulers employed by the company.
D. Provide a list of all receiving facilities, along with the address and phone number for each location. All receiving facilities must be registered
with the Missouri Department of Natural Resources.
SECTION 6 - REGULATORY PERMIT FEES
The application for a waste tire permit must be accompan ied with the $100 permit fee. This fee is nonrefundable. Checks can be made to Director
of Revenue.
SECTION 7 – SAFETY COMPLIANCE & SIGNATURE
Read this section carefully before signing and submitting the applicati on. The company is bound by commercial motor vehicles safety regulations.
Information about the safety regulations that apply to waste tire permit holders can be found in the Safety & Compliance section of the MoDOT
Motor Carrier Services website at www.modot.org/mcs.
The application must be signed to be accepted . If an individual other than the applicant signs the application, proof of power of attorney must be
submitted. If the applicant is a corporation, an officer of the company or an individual authorized to sign on behalf of the company may sign the
application. A member or manager of an LLC may sign the application as long as the member or manger is authorized to sign on behalf of the LLC as
stated in the articles of incorporation or operating agreement.
