RESET OREGON DEPARTMENT OF TRANSPORTATION MOTOR CARRIER TRANSPORTATION DIVISION 3930 FAIRVIEW INDUSTRIAL DRIVE SE SALEM OR 97302-1166 PH (503) 378-6699 FAX (503) 378-6880 PRINT OREGON WEIGHT RECEIPT AND TAX IDENTIFIER APPLICATION CONTINUATION SHEET ACCOUNT NUMBER SUB ST/PROV BASE LICENSE NO OWNED BUSINESS NAME EFFECTIVE DATE YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER LESSOR FUEL UNIT NUMBER VT ODO READING HUB KM LEASED SOLO AXL COMB #1 AXL COMB #2 AXL COMB #3 AXL COMB #4 AXL FEE BASIS BD REASON FOR APPLICATION ADD VEHICLE RENEW VEHICLE ST/PROV BASE LICENSE NO OWNED AMEND VEHICLE (LIST VARIABLE BEING AMENDED) CANCEL VEHICLE YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER LESSOR FUEL UNIT NUMBER VT ODO READING HUB KM LEASED SOLO AXL COMB #1 AXL COMB #2 AXL COMB #3 AXL COMB #4 AXL FEE BASIS BD REASON FOR APPLICATION ADD VEHICLE RENEW VEHICLE ST/PROV BASE LICENSE NO OWNED AMEND VEHICLE (LIST VARIABLE BEING AMENDED) CANCEL VEHICLE YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER LESSOR FUEL UNIT NUMBER VT ODO READING HUB LEASED KM SOLO AXL COMB #1 AXL COMB #2 AXL COMB #3 AXL COMB #4 AXL FEE BASIS BD REASON FOR APPLICATION ADD VEHICLE RENEW VEHICLE ST/PROV BASE LICENSE NO OWNED AMEND VEHICLE (LIST VARIABLE BEING AMENDED) CANCEL VEHICLE YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER LESSOR FUEL UNIT NUMBER VT ODO READING HUB LEASED KM SOLO AXL COMB #1 AXL COMB #2 AXL COMB #3 AXL COMB #4 AXL FEE BASIS BD REASON FOR APPLICATION ADD VEHICLE RENEW VEHICLE ST/PROV BASE LICENSE NO OWNED AMEND VEHICLE (LIST VARIABLE BEING AMENDED) CANCEL VEHICLE YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER LESSOR FUEL UNIT NUMBER VT ODO READING HUB LEASED KM SOLO AXL COMB #1 AXL COMB #2 AXL COMB #3 AXL COMB #4 AXL FEE BASIS BD REASON FOR APPLICATION ADD VEHICLE RENEW VEHICLE ST/PROV BASE LICENSE NO OWNED AMEND VEHICLE (LIST VARIABLE BEING AMENDED) CANCEL VEHICLE YEAR MAKE COMPLETE VEHICLE IDENTIFICATION NUMBER LESSOR FUEL UNIT NUMBER VT ODO READING HUB LEASED SOLO KM AXL COMB #1 AXL COMB #2 AXL COMB #3 AXL REASON FOR APPLICATION ADD VEHICLE FORM 735-9076A (10-14) RENEW VEHICLE CANCEL VEHICLE AMEND VEHICLE (LIST VARIABLE BEING AMENDED) COMB #4 AXL FEE BASIS BD
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