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IOWA INTERNATIONAL REGISTRATION PLAN VEHICLE SCHEDULE
Form 442015 (08-17)
Office of Vehicle & Motor Carrier Services P.O. Box 10382 Des Moines, IA 50306-0382
Phone: (515) 237-3268 FAX: (515) 237-3225
Email: [email protected] Web: iowadot.gov/mvd/omcs
Registrant Name
1
Unit Number
4 Per Y/N
23
Dealer Name and Address or
Previous License # MM/YY of Expiration
and State
22
** Y/N
21
USDOT No. Corresponding
Tax ID No.
20
Y/N
19
Transferred License Plate No.and Sticker No.
18
1st Operated
Date M/D/Y
17 Purchase
Date M/D/Y
16
Lease Date
M/D/Y
15
Factory Price
14
Purchase
Price
13 Weight Group
Number
12
Gross Combined
Weight
11
Unladen Weight
10
Jurisdiction Abbrev.
& Title Number
9
Complete Vehicle
Identification Number
8
Axle Seats
or Axles
7
Fuel
6
Make
5
* Type
3
Year
2
Owner Name
Doing Business as
Second Address Line
AL MALAKYKSINILIDIAGAFLDEDCCTCOCAAZAR
NS SKQCPEON
PA NLNBMBBCABWYWVWIWAVTVAUTTXTNSDSCRI
MD OROKOHNYNVNMNJNHNENDNCMTMSMOMNMIME
Physical Address
Registrant OnlyClient ID Registrant's Phone Number
Fleet Number
FAX Number
License Year
USDOT Number
Tax ID Number
Mailing Address
Second Address Line
Contact Person Name - Regarding Application
City,State, ZIP Code Contact Person Email Address Registrant Email AddressContact Person Phone Number
City,State, ZIP Code
Temporary Evidence of Apportionment (TEAR) requested?
If you are a Motor Carrier you will need a US DOT Number to enter into the US DOT Number space.
IA DOT OFFICE USE ONLY Supp # Date
Reg. Mos. Initials
Registration Month: No Yes
*If registering a power unit, will you be pulling a trailer? ** Will the control and responsibility for the safety of this vehicle be assigned to a different motor carrier during the registration year?
ADDITIONS
(See Reverse Side For Instructions and Codes.)
No Yes No Yes
Straight Deletions or Deletions/Transfer of Credit
Unit NumberComplete Vehicle
Identification NumberDeletion DateMM/DD/YY Plate Number Reason Removed
Units listed below will be authorized to operate in the jurisdictions and at the weights listed below. List weights in the box for each jurisdiction.
24
Utah TK
Type MCO
Replacement cab card $3.00 Duplicate Credential Requests Sticker (includes cab card) $3.50 Plate (includes cab card & sticker) $10.00 Fleet-to-Fleet Transfer I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct.
Title:
By:
Date:
5S --
Per
man
ent S
emi T
raile
r (5-
year
bill
ing)
App
licat
ion
Inst
ruct
ions
a.
Del
etio
n O
nly
- if y
ou a
ntic
ipat
e ad
ding
a u
nit i
t is
reco
mm
ende
d yo
u ho
ld y
our d
elet
ion
until
that
tim
e to
max
imiz
e yo
ur tr
ansf
er c
redi
t. If
you
do
not a
ntic
ipat
e an
add
, ple
ase
com
plet
e a
vehi
cle
sche
dule
, and
cla
im fo
r ref
und
refo
rm. S
ubm
it th
ese
form
s al
ong
with
the
vehi
cle
plat
e
a
nd re
gist
ratio
n to
the
Iow
a D
epar
tmen
t of T
rans
porta
tion,
Offi
ce o
f Veh
icle
& M
otor
Car
rier S
ervi
ces,
P.O
. Box
103
82, D
es M
oine
s, IA
5
0306
-038
2.
b.
Del
etio
n an
d A
dditi
on (T
rans
fer o
f Cre
dit)
- whe
n a
plat
e is
tran
sfer
red
from
a d
elet
ed u
nit t
o an
add
ed u
nit a
veh
icle
sch
edul
e m
ust b
e co
mpl
eted
. c.
W
eigh
t inc
reas
e - c
ompl
ete
colu
mns
1, 9
, and
12,
indi
cate
the
desi
red
wei
ght i
n th
e ju
risdi
ctio
n bo
x ab
ove.
Com
plet
e th
e bo
xes
on th
e to
p se
ctio
n of
the
sche
dule
. The
reg
istra
nt’s
info
rmat
ion,
incl
udin
g na
me,
DB
A (
if ap
plic
able
), ph
ysic
al a
ddre
ss, c
ity, s
tate
, zip
co
de,
the
com
plet
e m
ailin
g ad
dres
s, (
if di
ffere
nt t
han
the
phys
ical
add
ress
), an
d re
gist
rant
’s p
hone
num
ber
and
emai
l add
ress
. Th
e co
unty
num
ber
is
requ
ired
for “
New
Car
riers
” onl
y. T
he n
ame
and
tele
phon
e nu
mbe
r of t
he c
onta
ct p
erso
n w
ho is
resp
onsi
ble
for f
illin
g ou
t the
app
licat
ion
mus
t be
ente
red.
A
Tax
ID n
umbe
r (TI
N) m
ust b
e gi
ven,
this
is e
ither
a F
eder
al id
entif
icat
ion
num
ber (
FEIN
) or a
Soc
ial S
ecur
ity n
umbe
r (S
SN
), an
FE
IN is
pre
ferr
ed. I
f you
are
a
mot
or c
arrie
r yo
u w
ill n
eed
to e
nter
you
r U
S D
OT
Num
ber
in th
e U
SD
OT
num
ber
spac
e. If
you
are
not
a m
otor
car
rier,
you
shou
ld c
heck
the
regi
stra
nt
only
box
, (yo
u w
ill n
ot n
eed
to e
nter
a U
SD
OT
num
ber)
. Li
st th
e de
sire
d w
eigh
ts in
pou
nds
for e
ach
appo
rtion
ed ju
risdi
ctio
n. V
ehic
les
regi
ster
ed a
t 55,
000
poun
ds o
r mor
e m
ust p
rovi
de c
urre
nt v
erifi
catio
n of
Hea
vy
Veh
icle
Use
Tax
For
m 2
290.
See
IRP
Man
ual f
or a
ccep
tabl
e do
cum
enta
tion.
Doc
umen
tatio
n ca
n ac
com
pany
you
r veh
icle
sch
edul
e or
be
subm
itted
at t
ime
of p
aym
ent.
Col
umn
7
F
uel t
ype:
D
-- D
iese
l G
-- G
as
O
-- O
ther
C
olum
n 8
Num
ber o
f axl
es. V
ehic
les
othe
r tha
n bu
sses
sho
uld
list t
he n
umbe
r of a
xles
in th
e to
p po
rtion
. Pow
er u
nits
nee
d to
list
the
max
imum
num
ber o
f
axl
es fo
r pow
er u
nit a
nd tr
aile
r in
the
low
er p
ortio
n. B
usse
s ne
ed to
list
num
ber o
f sea
ts in
the
botto
m p
ortio
n.
Col
umn
9
V
IN n
umbe
r. A
com
plet
e ve
hicl
e id
entif
icat
ion
num
ber m
ust b
e us
ed.
Col
umn
10
T
itle
num
ber.
Doc
umen
tatio
n m
ust b
e pr
ovid
ed. S
ee IR
P M
anua
l for
acc
epta
ble
docu
men
tatio
n. D
ocum
enta
tion
can
acco
mpa
ny y
our V
ehic
le
S
ched
ule
or b
e su
bmitt
ed a
t tim
e of
pay
men
t. C
olum
n 11
Em
pty
wei
ght.
Col
umn
12
Io
wa
com
bine
d gr
oss
wei
ght f
or w
hich
the
unit
is to
be
regi
ster
ed.
Col
umn
13
W
eigh
t gro
up n
umbe
r for
this
uni
t. C
olum
n 14
Pur
chas
e pr
ice
of u
nit w
hen
acqu
ired.
(Exc
ludi
ng tr
ade-
in a
nd s
ales
tax
but i
nclu
ding
acc
esso
ries
or m
odifi
catio
ns.)
Col
umn
15
T
he m
anuf
actu
rer's
fact
ory
pric
e, e
xclu
ding
trad
e-in
and
sal
es ta
x, in
clud
ing
acce
ssor
ies
or m
odifi
catio
ns a
ttach
ed to
the
vehi
cle.
If th
e fa
ctor
y pr
ice
i
s le
ft bl
ank
the
syst
em w
ill a
utom
atic
ally
fill
this
in u
sing
dat
a fro
m th
e M
anuf
actu
rer's
Sug
gest
ed R
etai
l Pric
e (M
SR
P).
Col
umn
16
L
ease
dat
e - i
f thi
s ve
hicl
e is
bei
ng le
ased
add
mon
th, d
ay a
nd y
ear.
Col
umn
17
P
urch
ase
date
- m
onth
, day
and
yea
r. C
olum
n 18
Mon
th a
nd y
ear t
he v
ehic
le w
as fi
rst p
ut in
ser
vice
, (if
on th
e tit
le o
nly
list).
C
olum
n 19
Lic
ense
pla
te a
nd s
ticke
r num
ber t
rans
ferr
ed fr
om th
e de
lete
d un
it (if
no
trans
fer w
rite
Non
e).
Col
umn
20
'Y
' if u
nit t
rave
ls o
ver 1
0,00
0 m
iles
natio
nally
a y
ear.
'N' i
f uni
t tra
vels
10,
000
mile
s or
less
nat
iona
lly a
yea
r (po
wer
uni
t onl
y).
Col
umn
21
U
SD
OT
num
ber a
ssig
ned
to v
ehic
le a
nd c
orre
spon
ding
Tax
Iden
tific
atio
n N
umbe
r of t
he M
otor
Car
rier R
espo
nsib
le fo
r the
saf
ety
of th
e ve
hicl
e.
See
IRP
Man
ual.
Col
umn
22
W
ill th
e co
ntro
l and
resp
onsi
bilit
y fo
r the
saf
ety
of th
is v
ehic
le b
e as
sign
ed to
a d
iffer
ent m
otor
car
rier d
urin
g th
e re
gist
ratio
n ye
ar?
Col
umn
23
P
revi
ous
licen
se in
form
atio
n, p
late
num
ber,
year
and
sta
te. I
f new
ly p
urch
ased
, giv
e de
aler
nam
e an
d ad
dres
s. F
or a
ny v
ehic
le
w
hich
has
bee
n st
ored
pre
viou
s to
this
lice
nsin
g yo
u m
ust s
ubm
it th
e or
igin
al s
tora
ge s
lip w
ith th
e ve
hicl
e sc
hedu
le.
Col
umn
24
T
op p
ortio
n: U
tah
Spe
cial
Tru
ck In
dica
tor:
If yo
ur p
ower
uni
t is
a: c
emen
t pum
p, w
ell-b
orin
g un
it, O
R c
rane
put
a Y
; if n
one
of th
ese,
leav
e
b
lank
.
B
otto
m p
ortio
n: If
you
r pow
er u
nit i
s ne
w p
ut a
n S
(a c
opy
of th
e M
anuf
actu
rer's
Cer
tific
ate
of O
rigin
(MC
O) m
ust b
e at
tach
ed to
this
form
);
O
ther
wis
e le
ave
blan
k.