Form PR-450-004 "Established Place of Business, Residency, or Change of Address" - Washington

What Is Form PR-450-004?

This is a legal form that was released by the Washington State Department of Licensing - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Washington State Department of Licensing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form PR-450-004 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

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Download Form PR-450-004 "Established Place of Business, Residency, or Change of Address" - Washington

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Established Place of Business,
Residency, or Change of Address
Use this form for new International Registration Plan (IRP) accounts, to provide your established place of business
address, or to record your change of address on an existing account. An established place of business is a physical
structure – not a post office address – that displays the account name, is owned or leased, and is located within the base
jurisdiction. It must be open during normal business hours. If you don’t have an established place of business, you must
show proof of residency in Washington.
Additionally, you must provide three documents demonstrating the established place of business or residency. Acceptable
documents must show the business or principal owner’s name and address and may include: a utility bill, property tax
payment, lease or mortgage document, or other verifiable documents that will identify the name and legal proof of a place
of business or residence in Washington State. For additional information regarding IRP address requirements, see Section
300 of The Plan at www.irponline.org.
Send this completed form and three supporting documents to:
Motor Carrier Services IRP Unit
Department of Licensing
PO Box 9228
Olympia, WA 98507-9228
Questions
Hours: 8:00–5:00, M–F, call (360) 664-1858 or visit our website at www.dol.wa.gov
Olympia counter hours:
8:30–4:30, M–F
Vancouver counter hours: 8:30–4:30, M–W, F and 9:00–4:30 TH
Customer information
Check one:
IRP new account
Existing IRP/IFTA customer change of address
Account name
IRP/IFTA Acct #
Fleet #
UBI #
USDOT #
Physical address
City
State
ZIP code
Mailing address (if different from above)
City
State
ZIP code
(Area code) Telephone number
Email address
Are the operational records of the company kept at this address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If no, provide the physical address and telephone number of the place where these records are kept:
Address
(Area code) Telephone number for location of records
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place
Signature
PR-450-004 (R/4/18)WA
Click here to START or CLEAR, then hit the TAB button
Established Place of Business,
Residency, or Change of Address
Use this form for new International Registration Plan (IRP) accounts, to provide your established place of business
address, or to record your change of address on an existing account. An established place of business is a physical
structure – not a post office address – that displays the account name, is owned or leased, and is located within the base
jurisdiction. It must be open during normal business hours. If you don’t have an established place of business, you must
show proof of residency in Washington.
Additionally, you must provide three documents demonstrating the established place of business or residency. Acceptable
documents must show the business or principal owner’s name and address and may include: a utility bill, property tax
payment, lease or mortgage document, or other verifiable documents that will identify the name and legal proof of a place
of business or residence in Washington State. For additional information regarding IRP address requirements, see Section
300 of The Plan at www.irponline.org.
Send this completed form and three supporting documents to:
Motor Carrier Services IRP Unit
Department of Licensing
PO Box 9228
Olympia, WA 98507-9228
Questions
Hours: 8:00–5:00, M–F, call (360) 664-1858 or visit our website at www.dol.wa.gov
Olympia counter hours:
8:30–4:30, M–F
Vancouver counter hours: 8:30–4:30, M–W, F and 9:00–4:30 TH
Customer information
Check one:
IRP new account
Existing IRP/IFTA customer change of address
Account name
IRP/IFTA Acct #
Fleet #
UBI #
USDOT #
Physical address
City
State
ZIP code
Mailing address (if different from above)
City
State
ZIP code
(Area code) Telephone number
Email address
Are the operational records of the company kept at this address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
If no, provide the physical address and telephone number of the place where these records are kept:
Address
(Area code) Telephone number for location of records
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place
Signature
PR-450-004 (R/4/18)WA