Form SFN2479 Schedule C "International Registration Plan - Supplemental Application" - North Dakota

What Is Form SFN2479 Schedule C?

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

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the North Dakota Department of Transportation;
  • 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 SFN2479 Schedule C by clicking the link below or browse more documents and templates provided by the North Dakota Department of Transportation.

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Download Form SFN2479 Schedule C "International Registration Plan - Supplemental Application" - North Dakota

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INTERNATIONAL REGISTRATION PLAN
MOTOR VEHICLE DIVISION
ND DEPT OF TRANSPORTATION
SUPPLEMENTAL APPLICATION (SCHEDULE C)
608 E BOULEVARD AVE SUITE 103
North Dakota Department of Transportation, Motor Vehicle
BISMARCK ND 58505-0791
Telephone (701) 328-1287
SFN 2479 (3-2019)
Fax (701) 328-3500
Website: https://dot.nd.gov
US DOT Number
FEIN/TIN
IRP Account Number
Fleet Number
License Year
Jurisdictional Use
Carrier Name
DBA Name
Business Street Address
City
State
Zip Code
Mailing Address
City
State
Zip Code
Address Change?
Contact Person
Name
Telephone Number
Fax Number
E-Mail
I declare, with my signature on my registration application, that I am knowledgeable of the the Federal or State Motor Carrier and Hazardous Materials Safety
Regulations.
The undersigned, under oath, swears under penalty of perjury that the information furnished in this application and the attached schedules are true and correct and
certifies that these vehicles will be insured as required by law (NDCC 39-08-20).
This Application must be signed and dated or it will be returned.
Signature of Applicant
Date
/
/
INTERNATIONAL REGISTRATION PLAN
MOTOR VEHICLE DIVISION
ND DEPT OF TRANSPORTATION
SUPPLEMENTAL APPLICATION (SCHEDULE C)
608 E BOULEVARD AVE SUITE 103
North Dakota Department of Transportation, Motor Vehicle
BISMARCK ND 58505-0791
Telephone (701) 328-1287
SFN 2479 (3-2019)
Fax (701) 328-3500
Website: https://dot.nd.gov
US DOT Number
FEIN/TIN
IRP Account Number
Fleet Number
License Year
Jurisdictional Use
Carrier Name
DBA Name
Business Street Address
City
State
Zip Code
Mailing Address
City
State
Zip Code
Address Change?
Contact Person
Name
Telephone Number
Fax Number
E-Mail
I declare, with my signature on my registration application, that I am knowledgeable of the the Federal or State Motor Carrier and Hazardous Materials Safety
Regulations.
The undersigned, under oath, swears under penalty of perjury that the information furnished in this application and the attached schedules are true and correct and
certifies that these vehicles will be insured as required by law (NDCC 39-08-20).
This Application must be signed and dated or it will be returned.
Signature of Applicant
Date
/
/
SFN 2479 (3-2019)
Page 2 of 3
IRP Account Number
All Columns Must be Completed by Carrier
ADDITIONS
1
2
3
4
5
6
7*
8
9
10
11
A
B S
**
Y
T
X
U E
F
Fleet Number
ND
LICENSE
E
VEHICLE
Y
L
S A
U
TITLE
PLATE
UNIT
A
IDENTIFICATION
P
E
T
E
EMPTY
NUMBER
NUMBER
NUMBER
R
MAKE
NUMBER
E
S
S
L
WEIGHT
*TYPE (Column Number 7)
TT - TRUCK TRACTOR
TR - TRACTOR
TK - TRUCK (SINGLE)
RT - ROAD TRACTOR
BS - BUS
Carrier Responsible for Safety
12
13
14
15
**FUEL (Column Number 10)
16
17
18
***
D - DIESEL
NAME OF OWNER
DATE OF
ORIGINAL
LATEST
USDOT#
FEIN/TIN
Safety Resp
G - GASOLINE
(as listed on title)
PURCHASE
PRICE
PRICE
Vehicle Level
Vehicle Level
Change Y/N
P - PROPANE
*** (Column Number 18)
Is the carrier responsible
for safety expected to
change during the year?
DELETIONS
1
2
3
4
5
6
7
Y
LICENSE
DELETED
E
VEHICLE
PLATE
UNIT
A
IDENTIFICATION
NUMBER
NUMBER
R
MAKE
NUMBER
WEIGHT
REASON REMOVED
LIST COMBINED GROSS WEIGHT ON PAGE 3 FOR APPORTIONED JURISDICTIONS.
SFN 2479 (3-2019)
Page 3 of 3
IRP Account Number
Fleet Number
GROSS WEIGHT SCHEDULE
The schedule must be completed and should indicate the combined gross weight in pounds for every jurisdiction. Vehicles must
be listed in the same unit order as on page 2.
ND
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
IA
Unit-
Unit-
Unit-
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
Unit-
Unit-
Unit-
MT
NC
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
Unit-
Unit-
Unit-
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
AB
BC
Unit-
Unit-
Unit-
MB
NB
NL
NS
NT
ON
PE
QC*
SK
YT
MX
Unit-
Unit-
Unit-
*QC - Requires the number of axles (2-6) for the combination of vehicles (tractor-truck-trailer)
Page of 3