Form UCR-2 "Unified Carrier Registration Form - Vehicles Owned and Operated for the 12 Month Period" - Nebraska

What Is Form UCR-2?

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-2 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-2 "Unified Carrier Registration Form - Vehicles Owned and Operated for the 12 Month Period" - Nebraska

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UNIFIED CARRIER REGISTRATION FORM—UCR-2
VEHICLES OWNED AND OPERATED FOR
THE 12 MONTH PERIOD ENDING June 30,
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. VEHICLE LIST
The above described carrier hereby declares that the following vehicles are THE TOTAL NUMBER OWNED AND OPERATED
FOR THE 12 MONTH PERIOD ENDING June 30,
MAKE
MODEL/GVWR/
LICENSE PLATE
VIN NUMBER
Number of Passengers
NUBER/STATE
A:
STRAIGHT TRUCKS
AND TRACTORS
B: MOTOR COACHES,
SCHOOL BUSES, MINI-
BUSES, VANS, AND
LIMOUSINES
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-2
VEHICLES OWNED AND OPERATED FOR
THE 12 MONTH PERIOD ENDING June 30,
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. VEHICLE LIST
The above described carrier hereby declares that the following vehicles are THE TOTAL NUMBER OWNED AND OPERATED
FOR THE 12 MONTH PERIOD ENDING June 30,
MAKE
MODEL/GVWR/
LICENSE PLATE
VIN NUMBER
Number of Passengers
NUBER/STATE
A:
STRAIGHT TRUCKS
AND TRACTORS
B: MOTOR COACHES,
SCHOOL BUSES, MINI-
BUSES, VANS, AND
LIMOUSINES
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-2 Continued
USDOT Number
MC or MX Number
FF Number
Carrier Name
Continued
MAKE
MODEL
LICENSE PLATE
VIN NUMBER
NUMBER/STATE
A: STRAIGHT TRUCKS
AND TRACTORS
B: MOTOR COACHES,
SCHOOL BUSES, MINI-
BUSES, VAN, AND
LIMOUSINES
Make additional copies of this sheet if needed.
Page
of
Revised 8/2014
Instruction sheet for UCR-2 Form
(NOTE: This form is provided to assist you in maintaining required information. Carriers may
also summit the requested data in electronic format or in a printout attached to this form.
Contact your state agency for acceptable data formats.)
When do I need to use this form?
If you obtained the vehicle count for the numbers you entered in Section 4 of the ____
UCR Registration Form from the number of vehicles you owned and operated for the 12-
month period ending on June 30, ___ (Option B), and your fleet count using this method
places you in a bracket with a lower fee than if you had selected Option A on the ____
UCR Registration Form, you must maintain a list of vehicles covered by your ____ UCR
Registration and provide this information on Form UCR-2 to your base state upon request.
Section 1. – General Information
Enter all identifying information for your company. The owner and DBA name should be
identical
to
what
is
on
file
for
your
USDOT
number
(see
http://safer.fmsca.dot.gov/CompanySnapshot.aspx).
Enter the principal place of
business address that serves as your headquarters and where your operational records
are maintained or can be made available.
Section 2. — Classification (Definitions)
“Motor carrier” means a person providing motor vehicle transportation for
compensation.
“Motor private carrier” means a person who provide interstate transportation of
property in order to support it primary line of business.
Section 3. — Vehicle List
List the Make, Model, License Plate Number and State, and Vehicle Identification Number
(VIN) of each vehicle you owned and operated for the 12-month period ending June 30,
____.
If you need addition room you may use the continuation sheet on page 2 of the UCR-2
form. You many make additional copies of this continuation sheet as needed.
Section 4. — Certification
The owner or an individual who has the power of attorney to sign on behalf of the owner
or owners must sign this for. This certification indicates that the information is correct
under penalty of perjury.
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