New York State Department of Motor Vehicles INTERNATIONAL REGISTRATION PLAN ACCOUNT #: SCHEDULE A & C — Part 5 VEHICLE #: A) VEHICLE IDENTIFICATION NUMBER G) UNLADEN H) SEATS I) COMBINED WT /AXLES AXLES O)SAFETY US DOT # T) PURCHASE PRICE B) YEAR D) C) MAKE J) COLOR K) OWNER NAME REGISTRATION AUTHORIZATION F) WHEELBASE L) TITLE DOC # M) TITLE DOC. N) SAFETY TAXPAYER ID # (TIN) JUR. _________________________ o FEIN P) Vehicle Safety responsibility will Q) SAFETY NAME change during the year? o Yes o No U) PURCHASE DATE E) FUEL/CYL VEHICLE TYPE V) FACTORY PRICE W) INS. CO. CODE o SSN R) FLEET VEHICLE # (OEN) S) MAXIMUM DESIRED WEIGHT X) CURRENT PLATE # Y) CURRENT PLATE CLASS Z) SPECIAL USE IF THE REGISTRANT IS NOT THE OWNER, fill in the information below. Proof of ownership, and proof of the OWNER’S name and date of birth, are required. Vehicle #_______ - Owner’s Name Is the vehicle leased? Date of Birth / Apt. No. Address City The person named in number 3 of Part 1 is authorized to register this vehicle in his/her name. Owner’s Authorized / / Date: Signature - / State o Yes Zip Code o No If signing for a corporation, print your full name and title here VEHICLE #: A) VEHICLE IDENTIFICATION NUMBER G) UNLADEN H) SEATS I) COMBINED WT /AXLES AXLES O)SAFETY US DOT # T) PURCHASE PRICE B) YEAR D) C) MAKE J) COLOR K) OWNER NAME REGISTRATION AUTHORIZATION F) WHEELBASE L) TITLE DOC # M) TITLE DOC. N) SAFETY TAXPAYER ID # (TIN) JUR. _________________________ o FEIN P) Vehicle Safety responsibility will Q) SAFETY NAME change during the year? o Yes o No U) PURCHASE DATE E) FUEL/CYL VEHICLE TYPE V) FACTORY PRICE W) INS. CO. CODE o SSN R) FLEET VEHICLE # (OEN) S) MAXIMUM DESIRED WEIGHT X) CURRENT PLATE # Y) CURRENT PLATE CLASS Z) SPECIAL USE IF THE REGISTRANT IS NOT THE OWNER, fill in the information below. Proof of ownership, and proof of the OWNER’S name and date of birth, are required. Vehicle #_______ - Owner’s Name Is the vehicle leased? Date of Birth / Apt. No. Address City The person named in number 3 of Part 1 is authorized to register this vehicle in his/her name. Owner’s Authorized / / Date: Signature - / State o Yes Zip Code o No If signing for a corporation, print your full name and title here VEHICLE #: A) VEHICLE IDENTIFICATION NUMBER G) UNLADEN H) SEATS I) COMBINED WT /AXLES AXLES O)SAFETY US DOT # T) PURCHASE PRICE B) YEAR D) C) MAKE J) COLOR K) OWNER NAME REGISTRATION AUTHORIZATION JUR. _________________________ o FEIN V) FACTORY PRICE W) INS. CO. CODE WEIGHT X) CURRENT PLATE # Y) CURRENT PLATE CLASS Z) SPECIAL USE IF THE REGISTRANT IS NOT THE OWNER, fill in the information below. Proof of ownership, and proof of the OWNER’S name and date of birth, are required. Is the vehicle leased? Date of Birth / Apt. No. City The person named in number 3 of Part 1 is authorized to register this vehicle in his/her name. Owner’s Authorized / / Date: Signature IRP-6A (4/11) o SSN R) FLEET VEHICLE # (OEN) S) MAXIMUM DESIRED Vehicle #_______ - Owner’s Name Address F) WHEELBASE L) TITLE DOC # M) TITLE DOC. N) SAFETY TAXPAYER ID # (TIN) P) Vehicle Safety responsibility will Q) SAFETY NAME change during the year? o Yes o No U) PURCHASE DATE E) FUEL/CYL VEHICLE TYPE / State o Yes Zip Code o No If signing for a corporation, print your full name and title here PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com PART 5 (continued) VEHICLE INFORMATION FOR NEW ACCOUNTS OR ADDITIONS ACCOUNT #: VEHICLE #: A) VEHICLE IDENTIFICATION NUMBER G) UNLADEN H) SEATS I) COMBINED WT /AXLES AXLES O)SAFETY US DOT # T) PURCHASE PRICE B) YEAR D) C) MAKE J) COLOR K) OWNER NAME REGISTRATION AUTHORIZATION F) WHEELBASE L) TITLE DOC # M) TITLE DOC. N) SAFETY TAXPAYER ID # (TIN) JUR. _________________________ o FEIN P) Vehicle Safety responsibility will Q) SAFETY NAME change during the year? o Yes o No U) PURCHASE DATE E) FUEL/CYL VEHICLE TYPE V) FACTORY PRICE W) INS. CO. CODE o SSN R) FLEET VEHICLE # (OEN) S) MAXIMUM DESIRED WEIGHT X) CURRENT PLATE # Y) CURRENT PLATE CLASS Z) SPECIAL USE IF THE REGISTRANT IS NOT THE OWNER, fill in the information below. Proof of ownership, and proof of the OWNER’S name and date of birth, are required. Vehicle #_______ - Owner’s Name Is the vehicle leased? Date of Birth / Apt. No. Address City The person named in number 3 of Part 1 is authorized to register this vehicle in his/her name. Owner’s Authorized / / Date: Signature - / State o Yes Zip Code o No If signing for a corporation, print your full name and title here VEHICLE #: A) VEHICLE IDENTIFICATION NUMBER G) UNLADEN H) SEATS I) COMBINED WT /AXLES AXLES O)SAFETY US DOT # T) PURCHASE PRICE B) YEAR D) C) MAKE J) COLOR K) OWNER NAME REGISTRATION AUTHORIZATION F) WHEELBASE L) TITLE DOC # M) TITLE DOC. N) SAFETY TAXPAYER ID # (TIN) JUR. _________________________ o FEIN P) Vehicle Safety responsibility will Q) SAFETY NAME change during the year? o Yes o No U) PURCHASE DATE E) FUEL/CYL VEHICLE TYPE V) FACTORY PRICE W) INS. CO. CODE o SSN R) FLEET VEHICLE # (OEN) S) MAXIMUM DESIRED WEIGHT X) CURRENT PLATE # Y) CURRENT PLATE CLASS Z) SPECIAL USE IF THE REGISTRANT IS NOT THE OWNER, fill in the information below. Proof of ownership, and proof of the OWNER’S name and date of birth, are required. Vehicle #_______ - Owner’s Name Is the vehicle leased? Date of Birth / Apt. No. Address City The person named in number 3 of Part 1 is authorized to register this vehicle in his/her name. Owner’s Authorized / / Date: Signature - / State o Yes Zip Code o No If signing for a corporation, print your full name and title here VEHICLE #: A) VEHICLE IDENTIFICATION NUMBER G) UNLADEN H) SEATS I) COMBINED WT /AXLES AXLES O)SAFETY US DOT # T) PURCHASE PRICE B) YEAR D) C) MAKE J) COLOR K) OWNER NAME REGISTRATION AUTHORIZATION JUR. _________________________ o FEIN V) FACTORY PRICE W) INS. CO. CODE WEIGHT X) CURRENT PLATE # Y) CURRENT PLATE CLASS Z) SPECIAL USE IF THE REGISTRANT IS NOT THE OWNER, fill in the information below. Proof of ownership, and proof of the OWNER’S name and date of birth, are required. Is the vehicle leased? Date of Birth / Apt. No. City The person named in number 3 of Part 1 is authorized to register this vehicle in his/her name. Owner’s Authorized / / Date: Signature IRP-6A (4/11) o SSN R) FLEET VEHICLE # (OEN) S) MAXIMUM DESIRED Vehicle #_______ - Owner’s Name Address F) WHEELBASE L) TITLE DOC # M) TITLE DOC. N) SAFETY TAXPAYER ID # (TIN) P) Vehicle Safety responsibility will Q) SAFETY NAME change during the year? o Yes o No U) PURCHASE DATE E) FUEL/CYL VEHICLE TYPE www.dmv.ny.gov / State o Yes Zip Code o No If signing for a corporation, print your full name and title here PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com