Form UCR-1 "Unified Carrier Registration Form - Vehicles Removed in Intrastate Transportation" - Nebraska

What Is Form UCR-1?

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

Form Details:

  • Released on April 1, 2019;
  • The latest edition provided by the Nebraska Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form UCR-1 by clicking the link below or browse more documents and templates provided by the Nebraska Department of Motor Vehicles.

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Download Form UCR-1 "Unified Carrier Registration Form - Vehicles Removed in Intrastate Transportation" - Nebraska

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UNIFIED CARRIER REGISTRATION FORM—UCR-1
VEHICLES REMOVED IN INTRASTATE TRANSPORTATION
UCR REGISTRATION YEAR
(NOTE: this form is provided to assist you in maintaining required information. Carriers may also submit the requested data
in electronic format or in a printout attached to this form. Contact Nebraska DMV for acceptable data formats.)
SECTION 1. GENERAL INFORMATION
USDOT Number
MC or MX Number
FF Number
Telephone Number
Fax Number
Legal Name
E-Mail Address
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
SECTION 3. VEHICLES USED EXCLUSIVELY IN INTRASTATE TRANSPORTATION
The above described carrier hereby declares that the following vehicles are used exclusively for intrastate transportation of
property, waste, or recyclable material:
MAKE
MODEL/GVWR/
LICENSE PLATE
VIN NUMBER
Number of Passengers
NUMBER/STATE
Use reverse side if needed.
SECTION 4. CERTIFICATION
I, the undersigned, under penalty for false statement, certify that the above information is true and correct and that I am authorized to execute and file this document
on behalf of the applicant. (Penalty provisions subject to the laws of Nebraska.
Name of Owner or Authorized Representative (Printed)
Date
Signature
Title
Revised 4/2019
UNIFIED CARRIER REGISTRATION FORM—UCR-1
VEHICLES REMOVED IN INTRASTATE TRANSPORTATION
UCR REGISTRATION YEAR
(NOTE: this form is provided to assist you in maintaining required information. Carriers may also submit the requested data
in electronic format or in a printout attached to this form. Contact Nebraska DMV for acceptable data formats.)
SECTION 1. GENERAL INFORMATION
USDOT Number
MC or MX Number
FF Number
Telephone Number
Fax Number
Legal Name
E-Mail Address
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
SECTION 3. VEHICLES USED EXCLUSIVELY IN INTRASTATE TRANSPORTATION
The above described carrier hereby declares that the following vehicles are used exclusively for intrastate transportation of
property, waste, or recyclable material:
MAKE
MODEL/GVWR/
LICENSE PLATE
VIN NUMBER
Number of Passengers
NUMBER/STATE
Use reverse side if needed.
SECTION 4. CERTIFICATION
I, the undersigned, under penalty for false statement, certify that the above information is true and correct and that I am authorized to execute and file this document
on behalf of the applicant. (Penalty provisions subject to the laws of Nebraska.
Name of Owner or Authorized Representative (Printed)
Date
Signature
Title
Revised 4/2019
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