Fillable Texas International Registration Plan Apportioned Application Schedule A

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Texas International Registration Plan Apportioned Application Schedule A

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Form MCD-356 (Rev. 09/21)
Texas International Registration Plan Apportioned Application
Schedule A
(Reg. Year)
OFFICE USE ONLY
HVUT Verified:
Ins. Verified:
Account Number Fleet Number Supplement
Unit # Plate # Purchase DateFactory PriceFuel ++
Unladen Wgt.
Gross Wgt. Purchase PriceMakeYear Axles Total Axles Type +
VIN *1 Colorado Trailer SeatsDocument #**
Yes
No
Owner Name Replace Plate
Yes
*2 CRFS USDOT *3 CRFS TAX ID
No Yes
*4 Y/N
* Special
Unit # Plate # Purchase DateFactory PriceFuel ++
Unladen Wgt.
Gross Wgt. Purchase PriceMakeYear Axles Total Axles Type +
VIN *1 Colorado Trailer SeatsDocument #**
Yes
No
Owner Name Replace Plate
Yes
*2 CRFS USDOT *3 CRFS TAX ID
No Yes
*4 Y/N
* Special
Unit # Plate # Purchase DateFactory PriceFuel ++
Unladen Wgt.
Gross Wgt. Purchase PriceMakeYear Axles Total Axles Type +
VIN *1 Colorado Trailer SeatsDocument #**
Yes
No
Owner Name Replace Plate
Yes
*2 CRFS USDOT *3 CRFS TAX ID
No Yes
*4 Y/N
* Special
VEHICLE INFORMATION LIST
Unit # Plate #
Date Removed from Fleet
MakeYear VIN Gross Wgt. Reason Credentials Surrendered
Account Name DBA Contact Person Account Expiration
Physical Texas Address County of Residence Mailing Address Phone No.
Fax No. Tax ID (FEIN or SSN)
City, State and Zip Code Region City, State and Zip Code Email Address
Secondary Phone No. US DOT # TxDMV#
+Type = BS (bus), TK (truck only), TT (truck-tractor). ++ Fuel = Diesel, Gas, Propane.
*1 - Colorado Trailer: If unit is Type TK (truck) with travel in Colorado, indicate either “yes” or “no” if the truck pulls a trailer in Colorado.
*2 - CRFS USDOT: Enter USDOT # for the Carrier Responsible for the Safety (CRFS) fitness of the vehicle.
*3 - CRFS TAX ID: Enter Tax ID # for the CRFS.
*4 - Y/N: Indicate if the CRFS of the vehicle is expected to change during this registration year.
*5 - Special Use: Indicate non-standard uses (i.e., carnival, dump truck, farm truck, logging, wrecker, pump/drill/crane, household goods, less than 10K miles)
** If Document # is not shown - Carrier must furnish proof of Texas title or Texas Registration Purposes Only receipt in order to register vehicle.
Total Units Added
Total Units Deleted
Section 305 Application
Page 1 of 2
Form MCD-356 (Rev. 09/21)
Texas International Registration Plan Apportioned Application
Schedule B
(Reg. Year)
Account Number Fleet Number
Account Name DBA Contact Person Account Expiration
Physical Texas Address County of Residence Mailing Address Phone No.
Fax No. Tax ID (FEIN or SSN)
City, State and Zip Code Region City, State and Zip Code Email Address
Secondary Phone No. US DOT # TX MCR#
Schedule B
List distance traveled in each jurisdiction in which this fleet traveled for the period of
July 1, 2020, through June 30, 2021.
Company
Partnership
Ownership Type (check one):
Corporation
Sole Owner
Operation Type (check one):
For Hire
Private Carrier
Rental Trailer
Hazardous Materials Carrier *
Certify that the actual distances traveled shown on this application includes all interstate and intrastate mileage and also includes all mileage operated under trip lease to another carrier.
*If the box indicating Hazardous Materials Carrier has been checked, the undersigned is declaring knowledge of the Application Provisions of any State Motor Carrier Safety Regulations or
Hazardous Materials Regulations.
I attest that all vehicles are insured while operated upon the public roads, as required by law. Proof of financial responsibility will be carried in each vehicle. This certifies that the applicable
highway usage taxes have been paid on the power units listed on the attached equipment list. Knowingly providing false information on an application filed with the department subjects
you to a third-degree felony under State Law. The undersighed under oath swears under penalty of purgery that the above statements including all infromation on this application are true and
correct.
The Texas Department of Motor Vehicles maintains the information collected on this form. With a few exceptions, you are entitled upon request to be informed about the information that we collect about you. Under §§552.021,
552.023, and 559.004 of the Texas Government Code, you are entitled to receive and review this information, and to have us correct erroneous information.
Signature
Title Date
Jurisdiction Distance
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Jurisdiction Distance
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Jurisdiction Distance
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Jurisdiction Distance
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland/Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Total Fleet Distance
Page 2 of 2
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Texas International Registration Plan Apportioned Application Schedule A

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Completed 19 December 2021

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