Fillable Printable Dmv Ucr 2017
Fillable Printable Dmv Ucr 2017
Dmv Ucr 2017
Motor Carrier Division PO Box 12984 Austin, TX 78711-2984
Form UCR-2017 (Rev. 08/16) Page 1 of 2
UNIFIED CARRIER REGISTRATION FORM - Year 2017
To register online go to WWW.UCR.IN.GOV
(See Page 2 for Instructions)
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 Broker Leasing Company Freight Forwarder
SECTION 3. FEES DUE-BROKERS, FREIGHT FORWARDERS AND LEASING COMPANIES ONLY
Note: If your company is also a motor carrier or motor private carrier, skip this section and go to section 4.
Brokers, freight forwarders and leasing companies (not a motor carrier combination), please submit the amount due of $76.00 in the form of a
credit card, Check or Money Order payable to Texas Department of Motor Vehicles and go to Section 7.
SECTION 4. NO. OF MOTOR VEHICLES - MOTOR CARRIER & MOTOR PRIVATE CARRIER
Check only one box:
The number of vehicles shown below has been taken from section 26 of your last reported MCS-150 form.
The number of vehicles shown below is the total number owned and operated for the 12-month period ending June 30, 2016.
LINE
NO.
NUMBER OF STRAIGHT TRUCKS
AND TRACTORS
(COLUMN A)
(COLUMN B)
NUMBER OF MOTOR COACHES, SCHOOL
BUSES, MINI-BUSES, VANS AND LIMOUSINES
(COLUMN C)
TOTAL
(COLUMN D)
1.
2.
Subtract:
w The number of vehicles on Line 1 in Column C above that has a vehicle capacity of 10 or less passengers,
including the driver.
w (Optional) The number of vehicles on Line 1 in Column A above that is used only in intrastate commerce.
*See Section 4, Line 2 of Instruction Sheet*
3.
(Optional) Add a number of vehicles not shown on Line 1 above that are:
w Commercial motor vehicles operating solely in intrastate commerce. (See instructions for definition of
commercial motor vehicle.)
w Used in commerce to transport passengers or property for compensation and have a GVWR or GVW of
10,000 lbs or less, or a passenger capacity of 10 or less, including the driver.
4.
Total Number of Vehicles (Line 1 minus Line 2 plus Line 3)
SECTION 5. FEE TABLE - MOTOR CARRIER & MOTOR PRIVATE CARRIER
0-2
Number of Vehicles Amount Due Number of Vehicles
$76
Amount Due
6-20 $452 101-1,000
Number of Vehicles
$7,511
3-5 $227 21-100 $1,576 1,001 or more $73,346
Amount Due
Using the number of vehicles in Section 4 Line 4 above, enter the Amount Due from the table above.
Note: Payment can be made in the form of Credit Card (MasterCard, Visa, American Express, or Discover), Check, or Money Order.
MAKE CHECKS PAYABLE TO: Texas Department of Motor Vehicles
A $1.00 fee will be charged for credit card transactions.
Exp. date: Credit Card No.
SECTION 6. FEES DUE - MOTOR CARRIER & MOTOR PRIVATE CARRIER
SECTION 7. 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 the registration state.)
Name of Owner or Authorized Representative (Printed) Date
Signature Title
Form UCR-2017 (Rev. 08/16)
Page 2 of 2
Instruction Sheet for 2017 UCR-TEXAS Carrier Registration
My Base State for UCR?
w If your principal place of business is TEXAS, you must use the UCR-TEXAS Application Form for 2017. Follow the instructions below to
complete the UCR-TEXAS Application Form for 2017.
w If your principal place of business is in Florida or a State in Mexico you may select Texas as your base State.
Section 1. - General Information
w 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.fmcsa.dot.gov/CompanySnapshot.aspx). Enter the address for the principal place of business that serves as your
headquarters and where your operational records are maintained or can be made available.
Section 2. - Classification
Use the Definitions below and select all that apply.
w "Motor carrier" means a person providing motor vehicle transportation for compensation.
w "Motor private carrier" means a person who provides interstate transportation of property in order to support its primary line of business.
w "Broker" means a person, other than a motor carrier, who sells or arranges for transportation by a motor carrier for compensation.
w "Leasing company" means a person or company engaged in the business of leasing or renting for compensation motor vehicles they own
without drivers to a motor carrier, motor private carrier, or freight forwarder.
w "Freight forwarder" means a person that arranges for truck transportation of cargo belonging to others, utilizing for-hire carriers to provide
the actual truck transportation, and also performs or provides for assembling, consolidating, break-bulk and distribution of shipments and
assumes responsibility for transportation from place of receipt to destination.
Section 3. - Fees Due - Brokers, Freight Forwarders and Leasing Companies Only
w Brokers, freight forwarders and leasing companies pay the lowest fee tier. If your company is also a private or for-hire motor carrier you will
skip this section of the application.
Section 4. - Number of Motor Vehicles - Motor Carrier & Motor Private Carrier
w Check the appropriate box indicating where you obtained the vehicle count for the numbers you entered into the table in this section.
w Line 1. In the table, enter the number of commercial motor vehicles you reported on your last MCS-150 form or the total number of
commercial motor vehicles owned and operated for the 12-month period ending June 30 of the year immediately prior to the year for which
the UCR registration is made. This table includes owned and leased vehicles (term of lease for more than 30 days).
w Line 2. Subtract the number of vehicles designed to transport 10 passengers or less, including the driver, that are included in Column C of
Line 1. (Optional). You may also subtract the number of property carrying vehicle used solely in intrastate commerce (never used to carry
interstate freight) that you included in Section 4, Column A. Vehicles counted in this section must be included/identified on your UCR
converted TxDMV Certificate. You may not enter on this line the number of passenger carrying vehicles included in Column C that were used
solely in intrastate commerce.
w Line 3. (Optional) You may add the number of owned commercial motor vehicles (straight trucks, tractors, motor coaches, school buses,
mini-buses, vans or limousines) that were used only in intrastate commerce if they were not included in Columns A or C above. You may also
include on this line the number of other self propelled vehicles used in interstate or intrastate commerce to transport passengers or property
for compensation that are not defined as a commercial motor vehicle that have a gross vehicle weight rating or gross vehicle weight of
10,000 pounds or less or a passenger capacity of 10 or less, including the driver.
w Line 4. Total Number of Vehicles. Total the number of vehicles shown in Column D. Use this total and go to the fee table in Section 5. Pay
the amount due for your total number of vehicles.
w Definition - "Commercial motor vehicle" (as defined under 49 USC Section 31101) means a self-propelled or towed vehicle used on the
highways in commerce principally to transport passengers or cargo, if the vehicle: (1) Has a gross vehicle weight rating or gross vehicle
weight of at least 10,001 pounds, whichever is greater; (2) Is designed to transport more than 10 passengers including the driver; or (3) Is
used in transporting material found by the Secretary of Transportation to be hazardous under section 5103 of this title and transported in a
quantity requiring placarding under regulations prescribed by the Secretary under section 5103."
Section 5. - Fee Table - Motor Carrier & Motor Private Carrier
w This table is the approved UCR fees you will pay depending upon the number of vehicles reported in Section 4. This fee may change from
year to year. Contact your base state if you do not have the fee table for the correct registration period.
Section 6. - Fee Due - Motor Carrier & Motor Private Carrier
w Enter the amount due for the total number of vehicles calculated in Section 4 in the box provided. If paying by check or money order, make
payable to: Texas Department of Motor Vehicles.
w If paying with a credit card, enter credit card information, including credit card number and expiration date. Note: A $1.00 fee will be charged
for credit card transactions.
Section 7. - Certification
w The owner or an individual who has a power of attorney to sign on behalf of the owner or owners must sign this form. This certification
indicates that the information is correct under penalty of perjury.
The Texas Department of Motor Vehicles maintains the information collected through this form. With few exceptions, you are entitled on request to be informed about the
information that we collect about you. Under Sections 552.021 and 552.023 of the Government Code, you also are entitled to receive and review this information. Under Section
559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect.
