Form OA 144M For-Hire Intrastate Operating Authority Certificate, License, or Permit Renewal Application - Virginia

Form oa144M or the "For-hire Intrastate Operating Authority Certificate, License, Or Permit Renewal Application" is a form issued by the Virginia Department of Motor Vehicle's.

Download a fillable PDF version of the Form oa144M down below or find it on the Virginia Department of Motor Vehicle's Forms website.

ADVERTISEMENT
FOR-HIRE INTRASTATE OPERATING AUTHORITY
OA 144M (07/01/2013)
CERTIFICATE, LICENSE, OR PERMIT
RENEWAL APPLICATION
PURPOSE:
Motor carriers use this form to renew their Intrastate Operating Authority Certificate, License and/or Permit(s) and provide
business operations information.
INSTRUCTIONS: Complete all sections. Unsigned applications cannot be processed. For-hire certificates/licenses can be denied, revoked or
suspended due to certain circumstances. Refer to
www.DMVNow.com
for specific denial/revocation/suspension reasons.
NOTE: Virginia statute allows for periodic background checks of for-hire passenger certificate and license holders. Your
renewal application will not be processed if form OA 141S (Information Release Authorization) is not submitted with
your renewal application when you have been notified a background check is requested.
SECTION 1 — AUTHORITY INFORMATION
Check all that apply:
Broker of Freight
Common Carrier-Regular Route
Household Goods
Sightseeing
Broker of Passenger
Contract Bus
Non-Emergency Medical
Taxicab
Transportation Carrier
Contract Passenger
Nonprofit / Tax Exempt
Bulk Property
Passenger Carrier
Common Carrier-Irregular Route
Employee Hauler
Property Carrier
Write the number of each certificate, license, and permit you are applying to renew. Attach a separate page if needed.
SECTION 2 — BUSINESS INFORMATION
BUSINESS NAME (For individual applicants, give your full legal name)
FEDERAL TAX IDENTIFICATION NUMBER/SSN
TRADE NAME OR DOING BUSINESS AS (if different from Business Name)
BUSINESS STREET ADDRESS (do not give P.O. Box)
CITY
STATE
ZIP CODE
BUSINESS MAILING ADDRESS (if different from above)
CITY
STATE
ZIP CODE
PRIMARY CONTACT PERSON NAME
TELEPHONE NUMBER
FAX NUMBER
PRIMARY CONTACT PERSON TITLE
PRIMARY CONTACT PERSON EMAIL ADDRESS
SECTION 3 — OTHER CARRIER INFORMATION
IRP ACCOUNT NUMBER (if applicable)
BASE STATE
IFTA LICENSE NUMBER (if applicable)
BASE STATE
FMCSA MC NUMBER (Federal Motor Carrier) (if applicable)
DOT NUMBER (if applicable)
SECTION 4 — BUSINESS ENTITY INFORMATION
4A. BUSINESS ENTITY TYPE (check one)
CORPORATION
PARTNERSHIP (Complete Section 4B below)
INDIVIDUAL
OTHER
4B. PARTNERSHIP INFORMATION (enter the following information for all partners)
FULL LEGAL NAME
SOCIAL SECURITY NUMBER
SECTION 5 — CERTIFICATION
I affirm that all taxes, fees, penalties, interest, and judgements due the Commonwealth of Virginia have been paid or satisfied and that I am in compliance with
the Worker's Compensation Act of Title 65.2 and with the Business, Professional, and Occupational License Tax requirements. I further certify and affirm that all
information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all
supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false
statement or representation on this form is a criminal violation. I understand that any Virginia Operating Authority certificate, license or permit issued to me can
be suspended and revoked if any of the information in the application is found to be untrue or inaccurate.
APPLICANT OR AUTHORIZED REPRESENTATIVE NAME
APPLICANT OR AUTHORIZED REPRESENTATIVE TITLE
APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE
DATE (mm/dd/yyyy)
FOR-HIRE INTRASTATE OPERATING AUTHORITY
OA 144M (07/01/2013)
CERTIFICATE, LICENSE, OR PERMIT
RENEWAL APPLICATION
PURPOSE:
Motor carriers use this form to renew their Intrastate Operating Authority Certificate, License and/or Permit(s) and provide
business operations information.
INSTRUCTIONS: Complete all sections. Unsigned applications cannot be processed. For-hire certificates/licenses can be denied, revoked or
suspended due to certain circumstances. Refer to
www.DMVNow.com
for specific denial/revocation/suspension reasons.
NOTE: Virginia statute allows for periodic background checks of for-hire passenger certificate and license holders. Your
renewal application will not be processed if form OA 141S (Information Release Authorization) is not submitted with
your renewal application when you have been notified a background check is requested.
SECTION 1 — AUTHORITY INFORMATION
Check all that apply:
Broker of Freight
Common Carrier-Regular Route
Household Goods
Sightseeing
Broker of Passenger
Contract Bus
Non-Emergency Medical
Taxicab
Transportation Carrier
Contract Passenger
Nonprofit / Tax Exempt
Bulk Property
Passenger Carrier
Common Carrier-Irregular Route
Employee Hauler
Property Carrier
Write the number of each certificate, license, and permit you are applying to renew. Attach a separate page if needed.
SECTION 2 — BUSINESS INFORMATION
BUSINESS NAME (For individual applicants, give your full legal name)
FEDERAL TAX IDENTIFICATION NUMBER/SSN
TRADE NAME OR DOING BUSINESS AS (if different from Business Name)
BUSINESS STREET ADDRESS (do not give P.O. Box)
CITY
STATE
ZIP CODE
BUSINESS MAILING ADDRESS (if different from above)
CITY
STATE
ZIP CODE
PRIMARY CONTACT PERSON NAME
TELEPHONE NUMBER
FAX NUMBER
PRIMARY CONTACT PERSON TITLE
PRIMARY CONTACT PERSON EMAIL ADDRESS
SECTION 3 — OTHER CARRIER INFORMATION
IRP ACCOUNT NUMBER (if applicable)
BASE STATE
IFTA LICENSE NUMBER (if applicable)
BASE STATE
FMCSA MC NUMBER (Federal Motor Carrier) (if applicable)
DOT NUMBER (if applicable)
SECTION 4 — BUSINESS ENTITY INFORMATION
4A. BUSINESS ENTITY TYPE (check one)
CORPORATION
PARTNERSHIP (Complete Section 4B below)
INDIVIDUAL
OTHER
4B. PARTNERSHIP INFORMATION (enter the following information for all partners)
FULL LEGAL NAME
SOCIAL SECURITY NUMBER
SECTION 5 — CERTIFICATION
I affirm that all taxes, fees, penalties, interest, and judgements due the Commonwealth of Virginia have been paid or satisfied and that I am in compliance with
the Worker's Compensation Act of Title 65.2 and with the Business, Professional, and Occupational License Tax requirements. I further certify and affirm that all
information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all
supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false
statement or representation on this form is a criminal violation. I understand that any Virginia Operating Authority certificate, license or permit issued to me can
be suspended and revoked if any of the information in the application is found to be untrue or inaccurate.
APPLICANT OR AUTHORIZED REPRESENTATIVE NAME
APPLICANT OR AUTHORIZED REPRESENTATIVE TITLE
APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE
DATE (mm/dd/yyyy)
ADVERTISEMENT