WI IRP/IFTA LEASE VERIFICATION Wisconsin Department of Transportation – Motor Carrier Registration Unit Between Owner/Operator and Lessee P.O. Box 7955 Wisconsin Department of Transportation Madison, WI 53707-7955 MV2852 3/2018 Article II, Section 234 of the IRP, Trans 177.07,Trans 152.101 FAX: 608-267-6886 The International Registration Plan (IRP) requires Wisconsin to verify that a lease exists between you (the owner operator) and the motor carrier. All IRP applicants applying as an owner operator will be required to submit this information before we can proceed with your application. Owner-Operator means a person, firm or corporation leasing an apportioned motor vehicle to a motor carrier using their US DOT and/or IFTA. The base jurisdiction shall verify that a lease exists between the owner-operator (lessor) and the motor carrier (lessee). Legal Name of Lessor (Owner) Titled Owner (If Different from Lessor) Name of Lessee (Company or Individual Leased To name must match exactly the name on the U.S. DOT and Authority Number) – Lessees U.S. DOT Number Lessees FEIN Number Vehicle(s) List (Attach additional pages if necessary) MAKE YEAR VEHICLE IDENTIFICATION NUMBER (VIN) STATE TITLED Date of Lease Begin Date (m/d/yyyy): End Date (m/d/yyyy): Fuel Tax Reporting, License and Decals Provided By IFTA Account Number Issuing Jurisdiction Lessor or Lessee LESSOR LESSEE X X (Lessor Signature) (Date Signed) (Lessee Signature) (Date Signed)
WI IRP/IFTA – LEASE VERIFICATION Between Owner/Operator and Lessee Wisconsin Department of Transportation MV2852 3/2018 Article II, Section 234 of the IRP, Trans 177.07,Trans 152.101 Wisconsin Department of Transportation Motor Carrier Registration Unit P.O. Box 7955 Madison, WI 53707-7955 FAX: 608-267-6886 The International Registration Plan (IRP) requires Wisconsin to verify that a lease exists between you (the owner operator) and the motor carrier. All IRP applicants applying as an owner operator will be required to submit this information before we can proceed with your application. Owner-Operator means a person, firm or corporation leasing an apportioned motor vehicle to a motor carrier using their US DOT and/or IFTA. The base jurisdiction shall verify that a lease exists between the owner-operator (lessor) and the motor carrier (lessee). Legal Name of Lessor (Owner) Titled Owner (If Different from Lessor) Name of Lessee (Company or Individual Leased To – name must match exactly the name on the U.S. DOT and Authority Number) Lessees U.S. DOT Number Lessees FEIN Number Vehicle(s) List (Attach additional pages if necessary) MAKE YEAR VEHICLE IDENTIFICATION NUMBER (VIN) STATE TITLED Date of Lease Begin Date (m/d/yyyy): End Date (m/d/yyyy): Fuel Tax Reporting, License and Decals Provided By Lessor or Lessee IFTA Account Number Issuing Jurisdiction LESSOR LESSEE X X (Lessor Signature) (Date Signed) (Lessee Signature) (Date Signed)
mv2852.docx