Form Ucr-2 "Unified Carrier Registration Form - Vehicles Operated for the 12-month Period" - Maine

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Unified Carrier Registration Form – UCR-2
For UCR Registration Year _____
Vehicles Operated for the 12-Month Period
Ended June 30, 20__
NOTE: This form is provided to assist you in maintaining required records. It is to be used only by motor carriers and freight
forwarders registering for the Unified Carrier Registration for the _____ UCR registration Year, who base their UCR fees on
the number of vehicles they operated for the 12-months ended June 30, 20_ . Carriers may also keep the information called
for here in electronic or other format acceptable to their base state.
REGISTRANTS ARE TO SUBMIT THIS FORM ONLY ON REQUEST BY THEIR BASE STATE:
DO NOT SUBMITT THE FORM WITH YOUR UCR REGISTRATION.
SECTION 1. GENERAL INFORMATION
USDOT Number
E-Mail Address
Telephone Number
Fax Number
Legal Name
Doing Business under the Following Name (DBA)
Principal Place of Business Street Address (See Instructions)
Principal Business City
Principal Business State
Zip Code
Mailing Street Address
Mailing City
Mailing State
Mailing Zip Code
SECTION 2. CLASSIFICATION – Check All That Apply
Motor Carrier
Motor Private Carrier
Freight forwarders
SECTION 3. VEHICLE LIST
The above described carrier or freight identified above operated the following vehicles under the U.S. DOT number entered above
during the 12-month period ended June 30, 20__, and no others. (Vehicles operated only on a short term lease may be excluded.)
MAKE
MODEL/GVWR/
LICENSE PLATE
STATE
VIN NUMBER
Number of Passengers
A: STRAIGHT TRUCKS
AND TRACTORS
B. MOTOR COACHES,
SCHOOL BUSES, MINI-
BUSES, VANS, AND
LIMOUSINES
Use reverse side if needed.
SECTION 4. CERTIFICATION
Name of Owner or Authorized Representative (Printed)
Date
Title
Signature
Unified Carrier Registration Form – UCR-2
For UCR Registration Year _____
Vehicles Operated for the 12-Month Period
Ended June 30, 20__
NOTE: This form is provided to assist you in maintaining required records. It is to be used only by motor carriers and freight
forwarders registering for the Unified Carrier Registration for the _____ UCR registration Year, who base their UCR fees on
the number of vehicles they operated for the 12-months ended June 30, 20_ . Carriers may also keep the information called
for here in electronic or other format acceptable to their base state.
REGISTRANTS ARE TO SUBMIT THIS FORM ONLY ON REQUEST BY THEIR BASE STATE:
DO NOT SUBMITT THE FORM WITH YOUR UCR REGISTRATION.
SECTION 1. GENERAL INFORMATION
USDOT Number
E-Mail Address
Telephone Number
Fax Number
Legal Name
Doing Business under the Following Name (DBA)
Principal Place of Business Street Address (See Instructions)
Principal Business City
Principal Business State
Zip Code
Mailing Street Address
Mailing City
Mailing State
Mailing Zip Code
SECTION 2. CLASSIFICATION – Check All That Apply
Motor Carrier
Motor Private Carrier
Freight forwarders
SECTION 3. VEHICLE LIST
The above described carrier or freight identified above operated the following vehicles under the U.S. DOT number entered above
during the 12-month period ended June 30, 20__, and no others. (Vehicles operated only on a short term lease may be excluded.)
MAKE
MODEL/GVWR/
LICENSE PLATE
STATE
VIN NUMBER
Number of Passengers
A: STRAIGHT TRUCKS
AND TRACTORS
B. MOTOR COACHES,
SCHOOL BUSES, MINI-
BUSES, VANS, AND
LIMOUSINES
Use reverse side if needed.
SECTION 4. CERTIFICATION
Name of Owner or Authorized Representative (Printed)
Date
Title
Signature
UNIFIED CARRIER REGISTRATION FORM UCR-2 Continued
USDOT Number
Carrier Name
VEHICLE LIST CONTINUED
MAKE
MODEL/GVWR/
LICENSE PLATE
STATE
VIN NUMBER
Number of
Passengers
A: STRAIGHT TRUCKS
AND TRACTORS
B. MOTOR COACHES,
SCHOOL BUSES,MINI-
BUSES, VANS, AND
LIMOUSINES
Make additional copies of this sheet if needed
Page _____ of _____

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