Indiana Department of Revenue Application For Yard Tractor Permit FORM YT-1 Annual Permit Fee: $40.00 Revised 03/98 State Form 47692 Company Name IFTA Motor Account # DBA Name IRP Account # Address US DOT# City State Zip Code County Federal or SS# Telephone Number TID# Address of Terminal Locations (Indiana Only) Address City Address City Address City Address City Terminal #1 Terminal #2 Terminal #3 Terminal #4 This Yard Tractor Permit is an annual permit and applies to all yard tractors operated by the named carrier. This permit is not transferrable to another carrier. Under no circumstances does this permit allow the carrier to carry cargo or transport or draw a semitrailer or other vehicle under the permit. A carrier may operate a yard tractor under the permit instead of paying tax imposed under this chapter. Yard tractor refers to a tractor that is used to move semitrailers around a terminal or a loading or spotting facility. Any person in violation of the strict authorization granted by the above requested permit may be subject to fines, impoundment of all vehicles in violation and revocation of all operating permits issued by the Department. Over + American LegalNet, Inc. www.FormsWorkflow.com YT-1 Page 2 Indiana Department of Revenue Application For Yard Tractor Plates Plate Fee: $5.00 Number of Plate(s) Requested: .............................................................................................. Multiplied by $5.00 Plate Fee: ................................................................................................ $ X 5.00 Equals Total Plate Fee: .......................................................................................................... $ .00 The Yard Tractor plate is to be displayed on a yard tractor. The plate can be transferred between yard tractors operated by the carrier. The yard tractor must be designated as a yard tractor permitted to operate on a public highway. Under no circumstances does this plate allow the carrier to carry cargo or transport or draw a semitrailer or other vehicle on a public highway. Any person in violation of the strict authorization granted by the carrier requested plate(s) may be subject to fines, impoundment of all vehicles in violation and revocation of all operating plates issued by the Department. Summary of Fees Due Annual Permit Fee Due: ......................................................................................................... $ 40.00 Total Plate Fee(s) Due: ........................................................................................................... $ Total Fee(s) Due: .................................................................................................................... $ .00 .00 Please make Check or Money order payable to the Indiana Department of Revenue. Under penalty of perjury, I declare that I have examined this Yard Tractor application and to the best of my knowledge and belief it is true, correct and complete. I further declare that I will distribute the Yard Tractor permit issued to me by the Indiana Department of Revenue only in vehicles that I am operating or causing to be operated. Taxpayer or Authorized Agent Typed or Printed Name Title Date Signed Telephone Number ( Return To: ) State of Indiana Department of Revenue Motor Carrier Services Division P.O. Box 6175 Indianapolis, Indiana 46206-6175 American LegalNet, Inc. www.FormsWorkflow.com