IRP Form T-138 (Legal Size) Rev 07-2005 Georgia IRP Application Vehicle Schedule A (Legal Size) www.dor.ga.gov Page 1 of 2 SECTION 1 Before completing this application please read all of the instructions on page #2 of this form or click on the links to see specific instructions. Except for the signature, type, legibly handprint or complete on-line and print. (1) New Account? No Yes If “yes”, attach Schedule G (Form T-239) (2) 5-Digit Georgia IRP Account # (3) 3-Digit Georgia Fleet # (4) 3-Digit Georgia Supplement # (5) Registrant’s US DOT # (6) Federal Employer Identification # (FEIN) or Social Security # (7) Registrant's/Carrier’s Full, Legal Name and Business Address in Georgia including city, state and zip code. If the Registrant/Carrier is an individual, record first name, middle name and last name. A post office box is not acceptable. (7a) Georgia County Name (8) Registrant’s/Carrier’s Mailing Address, including city, state and zip code if different from the address recorded above in #7. A post office box is acceptable. (9) Registrant’s/Carrier’s Business Telephone # including area code (9a) Registrant’s/Carrier’s Cell Phone # including area code (9b) Registrant’s/Carrier’s Fax # including area code (9c) Registrant’s/Carrier’s Internet E-mail Address (10) Contact Person’s Name: (10a) Contact Person’s Telephone # including area code (10b) Contact Person’s Fax # including area code (10c) Contact Person’s Internet E-mail Address (11) Wyoming Intrastate? Yes No (12) Type of Operation – Check the box that applies to your operation: Private Carrier All Commodities Straight Truck – Agriculture/Fertilizer Truck -Tractor – Fertilizer/Milk/Crops Farm Vehicle – Farm Products/Farm Equipment Forest Products - Check one box below: [ ] Twin Beam Trailer [ ] Single Pole Trailer For Hire Carrier All Commodities Household Goods Bus – Record number of seats: _________ SECTION 2 (13) Reason for the IRP Application The letters after each reason indicate the documents that must be included with this IRP application. After checking the reason for this application, check the same letters in column (14) and submit the required documents with this application. New Applicant operating under your own authority – A, B, D, E, F, H, K, L & M New Applicant operating under another’s authority – A, B, D, E, F, G, H, I, K, L & M Renewal operating under your own authority – A, B, D, F, H, J, L & M Renewal operating under another’s authority – A, B, D, F, G, H, I, J, L & M Add Jurisdiction(s) – A & B Add Weight Group – A Change Type of Operation – A & B Change USDOT Information –A & J Corrections [ ] Address – A & M [ ] Name – A [ ] Mileage - B Fleet to Fleet Transfer – A, B & C Increase Weights – A & D Vehicle Transfer (Add/Delete Vehicles) – C (1) Weight Group Number: ______________________ If you are a first-time Georgia IRP registrant, leave this field blank and a number will be assigned. (2) Record the maximum gross vehicle weight that each vehicle in this fleet will travel in the following jurisdictions: (14) Required Document(s) Check the applicable boxes below indicating the documents that are being submitted with this application. The letters shown after each box you check should match the letters found in column (13) behind the reason for the IRP Application. A. This application, Vehicle Schedule A (Form T-138) B. Mileage Schedule B (Form T-139) C. Supplemental Application Schedule C (Form T-140) D. IRS Heavy Vehicle Use Tax Receipt, Form 2290, current, stamped, if vehicle’s gross weight is 55,000 lbs. or more E. New Applicant Schedule G (Form T-239) F. Insurance Card (copy) G. Employment Lease Contract with the Carrier H. Georgia Driver’s License (copy) I. Equipment Lease Agreement, signed with signature notarized, if the Registrant/Carrier is not the vehicle owner J. Motor Carrier Services‘ Certification – Update annually from the FMCSA website, http://safer.fmcsa.dot.gov/ or call (404) 562-3620. K. Report required motor carrier information to FMCSA –on-line from the FMCSA website, http://safer.fmcsa.dot.gov/ or call (404) 562-3620 L. One & the Same Affidavit - When the Registrant/Carrier Name & the Vehicle Owner Name differ, but are one & the same party. M. Proof of Georgia Residency/Established place of business Alabama (AL) California (CA) Georgia (GA) Kentucky (KY) Mexico (MX) Nebraska (NE) New Mexico (NM) Ohio (OH) Quebec (QC) Texas (TX) Wisconsin (WI) Alaska (AK) Colorado (CO) Idaho (ID) Louisiana (LA) Michigan (MI) Nevada (NV) New York (NY) Oklahoma (OK) Rhode Island (RI) Utah (UT) Wyoming (WY) Alberta (AB) Connecticut (CT) Illinois (IL) Maine (ME) Minnesota (MN) New Brunswick (NB) North Carolina (NC) Ontario (ON) Saskatchewan (SK) Vermont (VT) Yukon Territory (YT) Arizona (AZ) Delaware (DE) Indiana (IN) Manitoba (MB) Mississippi (MS) Newfoundland (NF) North Dakota (ND) Oregon (OR) South Carolina (SC) Virginia (VA) Arkansas (AR) District of Columbia (DC) Iowa (IA) Maryland (MD) Missouri (MO) New Hampshire (NH) Northwest Territory (NT) Pennsylvania (PA) South Dakota (SD) Washington (WA) British Columbia (BC) Florida (FL) Kansas (KS) Massachusetts (MA) Montana (MT) New Jersey (NJ) Nova Scotia (NS) Prince Edward (PE) Tennessee (TN) West Virginia (WV) SECION 3 Complete form T-138A if space for more vehicles is needed. (1) Unit/ Equip. # (2) Vehicle Identification Number (VIN) (3) # Of Axles or Seats (4) Empty Weight of Vehicle (5) Combined Gross Weight (6) Vehicle’s Purchase Price (7) Factory List Price (8) Owner’s Legal Name(s) (9) Georgia Title # (10) Short Term Lease/ Safety Change Ind. (Y/N) (11) Carrier’s FEIN # (12) US DOT # SECTION 4 Important: Do not send money with this application. You will be billed later. Application for IRP registration can be made by mail or in-person. (1) Under penalty of perjury, I hereby certify that I am the Registrant/Carrier or I am authorized to sign for the above named Registrant/Carrier. I further certify that the information shown on this form and all attachments is complete and correct: ______________________________________________________________ _________________________________________________ _________________________________________ ______________________ (Signature) (Printed Name) (Position or Job Title) (Date)
By publishing your document, the content will be optimally indexed by Google via AI and sorted into the right category for over 500 million ePaper readers on YUMPU.
This will ensure high visibility and many readers!
PUBLISH DOCUMENT No, I renounce more range.
You can find your publication here:
Share your interactive ePaper on all platforms and on your website with our embed function
