Form Mcs -1b - Kansas Apportioned Registrant Application Motor Carrier Services Bureau - Mileage Schedule B

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Rec
KANSAS APPORTIONED REGISTRANT APPLICATION
Ent
MOTOR CARRIER SERVICES BUREAU - MILEAGE SCHEDULE B
Bld
Phone 785-296-6541 Fax 785-296-6548
License Year
FEIN or SSN
Fleet Number
Account Number
Name of Registrant
DBA Name
Business Address (No PO Boxes)
Phone Number
City
County
State
Zip
Fax Number
Mailing Address
City
State
Zip
Contact Person
Phone Number
Optional Billing by vehicle?
Quarterly Payment?
KCC Number
MC Number
USDOT Number
Enter a "X" in the box in front of each IRP jurisdiction for which you are applying for apportioned registration and
have actual miles. *EST MILE- Place a "X" in this box if you want this jurisdiction on cab card and
do not have actual miles. Do not enter miles.
I certify that the information is true and correct: X ___________________________________
Date: __________________
EST
EST
EST
"X"
JURISDICTION
ACTUAL MILEAGE
"X"
JURISDICTION
ACTUAL MILEAGE
"X"
JURISDICTION
ACTUAL MILEAGE
MILE
MILE
MILE
AB- ALBERTA
MB-MANITOBA
OH-OHIO
AL-ALABAMA
MD-MARYLAND
OK-OKLAHOMA
AK-ALASKA
ME-MAINE
ON-ONTARIO
AR-ARKANSAS
MI-MICHIGAN
OR-OREGON
AZ-ARIZONA
MN-MINNESOTA
PA-PENNSYLVANIA
BC-BRIT. COLUMBIA
MO-MISSOURI
PE-PRINCE ED. IS.
CA-CALIFORNIA
MS-MISSISSIPPI
QC-QUEBEC
CO-COLORADO
MT-MONTANA
RI-RHODE ISLAND
CT-CONNECTICUT
MX-MEXICO
SC-SOUTH CAROLINA
DC-DIST.COLUMBIA
NB-NEW BRUNSWICK
SD-SOUTH DAKOTA
DE-DELAWARE
NC-NORTH CAROLINA
SK-SASKATCHEWAN
FL-FLORIDA
ND-NORTH DAKOTA
TN-TENNESSEE
GA-GEORGIA
NE-NEBRASKA
TX-TEXAS
IA-IOWA
NF-NEWFOUNDLAND
UT-UTAH
ID-IDAHO
NH-NEW HAMPSHIRE
VA-VIRGINIA
IL-ILLINOIS
NJ-NEW JERSEY
VT-VERMONT
IN-INDIANA
NM-NEW MEXICO
WA-WASHINGTON
KS-KANSAS
NS-NOVA SCOTIA
WI-WISCONSIN
KY-KENTUCKY
NT-N W TERRITORY
WV-WEST VIRGINIA
LA-LOUISIANA
NV-NEVADA
WY-WYOMING
MA-MASSACHUSETTS
NY-NEW YORK
YT-YUKON TERR
TOTAL MILES
MCS -1b (11/10)

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