FORM M-233DR State Form 49061 (R5 / 7-11) Indiana Department of Revenue Annual Mobile Home Rig Dealer's Permit Application Starting Date: January 1 Expiration Date: December 31 Fee: $40.00 Name of Transporting Company: FEIN: Address: SSN: (if sole proprietor) City, State, and Zip: Make of Tractor: Tractor Year: License State: Plate Number: Daytime Telephone: Fax Number: Vehicle Type: Full Vehicle Identification Number: Dealer's License Number: (As issued by the Bureau of Motor Vehicles) Overall Length: Up to 85' Overall Width: 8'6" up to 12'4" wide Overall Height: Legal Total Gross Weight: Legal Type of Permit: over 8'6" up to 12'4" Mobile Home Rig Dealer This TRACTOR MOBILE HOME RIG exceeds the legal size and weight limits and cannot be reduced by method of disassembly. This permit provides for transportation via all State and Interstate Highways officially opened to traffic except I-65 and I-70 inside I-465. No other routes, including detours, are authorized by this permit under any condition. The General Provisions on the reverse side of this form and any Special Provisions are incorporated by reference into this permit and are as fully binding upon the permittee as if they had appeared on the face of this permit. This permit is void or invalid if the General Provisions and Special Provisions are omitted from the reverse side of this form or are not attached. The Indiana Department of Revenue disclaims any responsibility in relation to the correctness in the transmitting of the permit as a whole or any part thereof, including general or special provisions. This permit is valid only for transporting commodities under the company name shown above, and if signed by both an authorized company owner or officer, and driver. The driver's signature attests to the fact that the description of the vehicle and load is accurate and that the General Provisions and any Special Provisions have been read and understood by the driver. Under the penalty of perjury, I have examined this permit, and to the best of my knowledge and belief, it is true, complete and correct. I also understand that all provisions of the Transporting Agreement apply in full force. Driver's Signature(s): Date(s): ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ __________________________________________ Company Owner or Responsible Officer Date ____________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Indiana Department of Revenue General Provisions of the M-233DR Annual Mobile Home Rig Dealer's Application The permitted vehicle must be marked on the front and rear with a sign reading "oversize load". The sign must be at least 18" high, at least 6' but not over 8' wide, and the letters must be black, 12" high, with a 2" stroke on yellow background. However, officially approved color combinations or wording of other states will be permitted when the trip originates outside Indiana. The permitted vehicle must have its low beam headlights on while transporting an oversize load. The permitted vehicle and/or load must be marked with 6 red flags. One of these will be placed as near to each corner of the vehicle and/or load as possible, and one will be placed on each side at the widest point. These flags must be in good condition, be plain red with no figures, be a minimum of 18" square, and be placed so that they can be seen clearly by approaching traffic. The operator of the permitted vehicle must be at least 18 years of age and hold a valid commercial driver's license. The driver of the permitted vehicle and/or load, or the person in direct charge of transporting such object, must have the permit in his possession during the transportation, and will show the permit, on demand, to any police officer or authorized employee of the State of Indiana. The mover and/or owner of the vehicle and/or load will be held responsible in the event that it is necessary to remove any buildings, railings, or other structures from the highway or in the event that any buildings, railings or other structures are damaged, said cost of the removal and/or damage shall be borne by the applicant. The permitted vehicle and/or load will at no time block traffic from the use of the highway, nor will equipment, load, or object be loaded or unloaded within the travelway, nor will vehicle or object be permitted to be parked either day or night on the shoulder or right-of-way. The permitted vehicle and load are not to be operated during the existence of hazardous weather, road, and traffic conditions, and/or when visibility is less than 500 feet. Oversize loads will not be operated at any time when wind velocity exceeds 25 miles per hour. This permit does not apply to any state roads or bridges that are closed for construction purposes, or to any roads or bridges that are posted for gross load limit and/or any structures, wires, etc., having a restricted height clearance that will not clear said load; or to any county roads or city streets. This permit is issued to the tractor designated on the reverse side of this form. It may not be utilized in conjunction with any other tractor. The original permit must be maintained in the permitted vehicle. A duplicate of the permit is not valid for purposes of any movement. Any violation of this permit will automatically cause the permit to be void, and upon violation, any police officer will have the authority to withdraw said permit. Operation without a valid permit may result in the issuance of citations for violation of applicable statutes. NOTICE TO ENFORCEMENT PERSONNEL: The Department of Revenue requests that you notify us as soon as possible after withdrawing this permit, and that you forward documentation clarifying the disposition of the citation as soon as possible. Please follow hours of operation and holiday restrictions found on the general provision sheet Form M-204. Must be kept in the truck during travel. Flagmen, in compliance with the provisions of the Indiana Manual on Uniform Traffic Control Devices, will be provided at all locations needing such traffic control. Locations requiring flagmen include, but are not limited to, encroachment into opposing traffic lanes and stops or blockage of traffic at locations where stops are not normally required by existing traffic control devices. The permitted vehicle whose dimensions exceed 8'6" wide, 13'6" high, and/or 80' long must not be operated at a speed in excess of 45 miles per hour. American LegalNet, Inc. www.FormsWorkFlow.com