MAILTO:POBOX2007,Frankfort,KY40602-2007

Phone:(502)564-1257Fax:(502)564-4138

Drive.Ky.Gov

Applicationfor

NewAuthority or AdditionalTrailers

ThisformcontainsdocumentsrequiredforapplicationsforUtilityTrailerauthorityandforadditionaltrailersunderanexistingauthority.Thefollowingsectionsare containedinthisapplicationform:

ApplicationIndex

To Apply for UtilityTrailer Authority

Youare required tofollowthese instructionstocomplete andmailor deliverthisapplication formincludingtheAuthorityApplication(Section2)andenclosetherequiredfeestotheTransportationCabinet,DepartmentofVehicleRegulation,DivisionofMotorCarriers,QualificationsandPermitsBranch,at200MeroStreet,Frankfort,KY 40622.Yourapplicationmaybereturnedfor the correctionofanydeficiencies.

Enclose a CheckorMoney Order

Youmustencloseonecheckormoneyordermadepayabletothe“KentuckyStateTreasurer”intheamountofthe$250applicationfeeplusthepermotorcarriervehiclefeeof$10.($250applicationfee)+(numberoftrailers Xpervehiclefeeof$10$ )=totalfees$ .

Register yourBusinessorBusinessName

BusinessOrganizationsMustRegisterwiththeKentuckySecretaryofState

IfyouareabusinessorganizationthatisrequiredtoberegisteredwiththeKentuckySecretaryofStateinordertodobusinessinKentucky,youshallcompleteyourregistrationasadomesticorforeignbusiness organizationpriortosubmittingthisapplication. Ifyou haveany questionsregardingtheregistrationprocesspleasecontactyourattorneyortheofficeoftheKentuckySecretaryofState.

SoleProprietorsMustFileaCertificateofAssumedNamewiththeCountyClerk

IfyouareoperatingyourbusinessasasoleproprietoryouarenotrequiredtoandmaynotregisteryourbusinessnamedirectlywiththeKentuckySecretaryofState,butyouarerequiredtofileacertificateofassumednamewith thecountyclerkwhereyoumaintainyourprincipalplaceofbusiness.CompleteandrecordtheenclosedCertificateofAssumedNameforSoleProprietor(Section

3)thenenclosetherecordedcopywiththisapplication.

Commercial Insurance

YouarerequiredtohaveaninsurancecarrierauthorizedtotransactbusinessinKentuckyfileaFormE,UniformMotorCarrierBodilyInjuryandPropertyDamageLiabilityCertificateofInsurancedirectly withtheDivisionofMotor Carriers prior tosubmitting thisapplication.TheForm Emust be an originalandmayonlybefiledbyyourinsurancecarrierbymaildirectlytotheDivisionofMotorCarriersorthroughtheMotorCarrierInformationExchange(NOR)website.Faxedcopiesshallnotbeaccepted.Ifyouhavequestionsregardinghowtosubmittheformpleasecontactyourinsurancecompany.Theminimumamountsofinsurancetobecarriedmustbe in compliance withKRS281.655(4).

Qualification ofTrailers

Youmustqualifyeachtrailertobeoperatedpursuanttoagrantofauthoritybeforeitmaybelawfullyoperatedunderthatauthority.YoumustcompleteandsubmittheenclosedAuthorityApplication(Section

2)forthenumberof trailers requiredtooperateas autilitytrailer lessor.

Applyingto Qualify AdditionalTrailers underanExistingAuthority

Youmayuse this applicationformto qualifyadditionaltrailersasanamendment toanexistingauthority.IfusingthisapplicationtorequesttheauthoritytoqualifyadditionaltrailersyoushallagainsubmittheAuthorityApplication(Section3)andencloseacheckormoneyordermadepayabletothe“KentuckyStateTreasurer”inanamountequalto$10perqualifiedtrailerfee.The$250applicationfeeisnotrequiredtoapplyforadditionaltrailers.

AuthorityandQualifiedVehicleCredentials

Foryour security, ifthe Department ofVehicle Regulation approvesyourapplication for newauthorityor foradditional qualifiedtrailers,theauthority andvehiclecredentialsissuedbythe departmentwillbe mailedbyfirstclassmailtoyourmailingaddressonfilewiththedepartment.Alternatively,thecredentialsmaybedeliveredinpersontoeitheraSoleProprietororanauthorizedofficerorregisteredagentoftheCorporation,Partnership,orLimitedLiabilityCompanylistedwiththeKentuckySecretaryofStatewhoseidentitycanbeverified.Youmayrequestovernightorotherexpeditedmaildeliverybysubmittingwiththisapplication a corresponding prepaidenvelope addressedtoyourmailingaddressonfile.

ApplicationProcessAssistance

Ifyouhavequestionsaboutthisapplicationformortheapplicationprocess,pleasecontacttheDepartmentofVehicleRegulation,DivisionofMotorCarriers,QualificationsandPermitsBranch,byphoneat(502).

PursuanttotheprovisionsofKRS365.015,theundersignedappliestoassumeanameand,forthatpurpose,submitsthe followingstatement:

1. The assumedname is:
2. The legalnameoftheindividualadoptingthe assumedname is:
3. The street address is:
CityCounty / StateZIP

4. The mailingaddress is:
CityCounty / StateZIP

IdeclareunderpenaltyofperjuryunderthelawsofKentuckythattheforegoingistrueandcorrect.
Signature
Printname / Date
THISSIGNATURESHALLBENOTARIZED.
STATEOF
COUNTYOF
Subscribedandsworntobeforemeonthis / theday of / 20 .
NotaryPublic
Mycommissionexpireson / .

Anassumednameshallbeeffectiveforatermof five (5)years fromthe dateoffilingandmay berenewed forsuccessivetermsuponfilingarenewalcertificatewithinsix(6)monthspriortotheexpirationoftheterm,inthesamemanneroffilingtheoriginalcertificateof assumedname.

Qualificationyear20

Companyno.

Legal name Doingbusiness as Mailingstreet address City County State Zip Phone Fax

Emailaddress(required)

Numberoftrailers
Pertrailer fee / X$10.00
Applicationfee / +$250.00 / (Newauthorityonly)
Totalfees

SignatureDatePrintname Printtitle

(Departmentuse)