Fillable MovingTowing Decal - New 1

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MovingTowing Decal - New 1

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File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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1 South Station, 5
th
Floor • Boston, MA 02110 • Tel: (617) 305-3559 • Fax: (617) 478-2598 • Email: DPU.Transportation@mass.gov
Moving and Towing Decal – New
Please note: a fee of $40 PER VEHICLE is required to process this application.
The Department now accepts payments online. Please visit our website for more information:
mass.gov/how-to/pay-transportation-oversight-division-fees
Busine
ss Name:
Address:
Mailing Address:
(if different)
Telephone:
Certificate Number:
REG#
TITLE #
YEAR
MAKE
TYPE
VEHICLE IDENTIFICATION NUMBER
Insurance Alert: The Department must have a current certificate of insurance on file. You can attach your insurance certificate to
this application:
Department of Public Utilities
Transportation Oversight Division
Please note: a fee is required to process this application.
Applications will not be processed without payment.
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.
THE FOLLOWING STATEMENT IS MADE UNDER THE PENALTIES OF PERJURY:
I, the undersigned, being duly authorized, hereby apply for a current year I.D. device(s) and affirm the statements herein are
true to the best of my knowledge and belief.
Signature: Date:
Title:
(Corporate partner/partner/owner)
For DPU Use Only App. Issue:
Computer Number:
Address OK?
Insurance OK?
What is my fee total per vehicle decal?
1: $40 10: $400
2: $80 11: $440
3: $120 12: $480
4: $160 13: $520
5: $200 14: $560
6: $240 15: $600
7: $280 16: $640
8: $320 17: $680
9: $360 18: $720
I'm sending a check/money order
I'm paying online
(Type full, legal name)
Submit Application by Email
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Completed 10 May 2020

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