SHIPPER'S CERTIFICATE OF WEIGHT

This Shipper's Certificate of Weight must be given to the motor carrier (or person) transporting a shipment before the motor carrier (or person) applies for an oversize/overweight permit.* This certification remains valid even when a permit is not purchased.

Under penalty of perjury, I, , an agent of the above-named shipper, certify that I am authorized to make this certification on behalf of the shipper listed above and I certify that the information provided on this certificate of weight is true and correct. Additionally, I agree that the shipper will submit any information requested by the Texas Department of Motor Vehicles that confirms the weight of the cargo in question. I also understand that any misrepresentation of cargo weight or any other information on this certification and/or the attachments, if any, can result in administrative penalties under Transportation Code §623.272.

Shipper:Name

Address City State ZIP

Telephone

Motor Carrier: Name

Cargo:Description of Cargo

Maximum Cargo Weight:

* If the shipment consists of multiple loads, parts and pieces, the attached itemized list of (# of )page(s) is incorporated by reference as if written and copied herein. The listing must indicate the weight of each piece and must be signed and dated on each page by the same person making this certification.

Place and date of Certification

Signature

TitlePrinted name of certifying agentCertifying Agent:

pounds

The Texas Department of Motor Vehicles maintains the information collected through this form. With few exceptions, you are entitled on request to be informed about the information that we collect about you. Under Sections 552.021 and 552.023 of the Government Code, you also are entitled to receive and review this information. Under Section 559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect.

Form 2280 (Rev. 07/17) Page 1 of 1