Fillable MOTOR CARRIER SERVICES PO BOX 270, 830 MODOT

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MOTOR CARRIER SERVICES PO BOX 270, 830 MODOT

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1
MISSOURI DEPARTMENT OF TRANSPORTATION
PHONE: 573.751.3358
MOTOR CARRIER SERVICES
FAX: 573.522.6708
PO BOX 270, 830 MODOT DRIVE, JEFFERSON CITY, MO 65102-0270
TOLL FREE: 866.831.6277 Option 3
FORM WT-2 – SUPPLEMENTAL PERMIT CERTIFICATE FOR TRANSPORTING WASTE TIRES
GENERAL INFORMATION:
NAME OF CARRIER
USDOT NO
TRADE OR DBA (DOING BUSINESS AS) NAME
PHONE NO
PRINCIPAL PLACE OF BUSINESS ADDRESS (Not a PO Box)
FAX NO
EMAIL ADDRESS
CHECK ONLY ONE:
ADDING POWER UNITS TRANSPORTING WASTE TIRES.
REPLACING A POWER UNIT TRANSPORTING WASTE TIRES.
List new vehicle(s) below and the unit number of vehicle being replaced. Mail a copy of bill of sale or Proof of Loss to issue this
replacement permit for more than 60 days.
LIST OF VEHICLE(S) BEING ADDED OR REPLACED:
Make
Type
(Tractor,
Truck, Box
Truck, etc)
Year
License
Plate –
STATE
License
Plate –
NUMBER
Company
Unit Number
Replaces Unit
Number
Gross
Vehicle
Weight
Rating
(GVWR)
Licensed Weight
of Vehicle
(Missouri Weight
Categories)*
* NOTE: Missouri Licensed Weight Categories are – 6,000, 12,000, 18,000, 24,000, 26,000, 30,000, 36,000, 42,000, 48,000, 54,000, 60,010, 66,000, 73,280, 78,000,
or 80,000 pounds. If your licensed vehicle weight is different from one of these numbers round up to the nearest weight listed.
SIGNATURE
APPLICANT(S) NAME PRINTED
APPLICANT(S) SIGNATURE
TITLE
DATE
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
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MOTOR CARRIER SERVICES PO BOX 270, 830 MODOT

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Completed 20 July 2020

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