Form 735-9685 - Oregon Apportioned Registration Schedule B

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PHONE: (503) 378-6643

OREGON DEPARTMENT OF TRANSPORTATION

RESET

OREGON APPORTIONED REGISTRATION

MOTOR CARRIER TRANSPORTATION DIVISION

FAX: (503) 378-5765

3930 FAIRVIEW INDUSTRIAL DRIVE SE

SCHEDULE B

SALEM OR 97302-1166

WEB:

NEW FLEET

ADDING JURISDICTIONS

RENEWAL

REGISTRATION YEAR

NAME ON ACCOUNT

FLEET NUMBER

ODOT USE

MCTD ACCOUNT NUMBER

EFFECTIVE DATE

SUPP NUMBER

Report all apportioned miles operated during the reporting period July 1 through June 30 of the preceding registration year for all vehicles on this fleet.

Check REGISTER box for each jurisdiction in which you wish to register.

When no actual miles were accrued in a selected jurisdiction during the reporting period, you must provide estimated miles. Refer to Schedule G, Oregon Estimated Distance Worksheet.

For each jurisdiction where miles are given, write in the TYPE box an "A" if miles are actual, an "E" if miles are estimated using Method 1, or a "C" if miles are estimated using Method 2 chart.

JURISDICTION

MILES

TYPE

JURISDICTION

MILES

TYPE

JURISDICTION

MILES

TYPE

ALBERTA

ALASKA

ALABAMA

ARIZONA

BRITISH COLUMBIA

ARKANSAS

CALIFORNIA

COLORADO

CONNECTICUT

DIST OF COLUMBIA

DELAWARE

FLORIDA

GEORGIA

IOWA

IDAHO

ILLINOIS

INDIANA

KANSAS

LOUISIANA

MASSACHUSETTS

KENTUCKY

MARYLAND

MAINE

MANITOBA

MINNESOTA

MISSOURI

MICHIGAN

MONTANA

MISSISSIPPI

MEXICO

NEW BRUNSWICK

NORTH CAROLINA

NORTH DAKOTA

NEWFOUNDLAND

NEW HAMPSHIRE

NEBRASKA

NOVA SCOTIA

NEW JERSEY

NEW MEXICO

NEVADA

NEW YORK

NW TERRITORIES

ONTARIO

OHIO

OKLAHOMA

PENNSYLVANIA

PRINCE EDWARD ISL

OREGON

QUEBEC

RHODE ISLAND

SOUTH CAROLINA

SASKATCHEWAN

TENNESSEE

SOUTH DAKOTA

TEXAS

UTAH

VIRGINIA

VERMONT

WASHINGTON

WISCONSIN

YUKON

WEST VIRGINIA

WYOMING

TOTAL ACTUAL AND ESTIMATED MILES

ODOT USE ONLY

I AM KNOWLEDGEABLE OF THE APPLICABLE FEDERAL MOTOR CARRIER SAFETY REGULATIONS AND HAZARDOUS MATERIALS REGULATIONS OR COMPATIBLE STATE REGULATIONS. I

APPROVED BY DATE INITIALS

UNDERSTAND THAT ORS 803.375 MAKES IT A CRIME TO KNOWINGLY PROVIDE FALSE INFORMATION RELATED TO A VEHICLE REGISTRATION. ORS 803.385 MAKES IT A CRIME TO

AFFIRM OR CERTIFY ANY INFORMATION RELATED TO A VEHICLE REGISTRATION THAT THE PERSON KNOWS TO BE FALSE. EACH OFFENSE IS A CLASS A MISDEMEANOR PUNISHABLE

BY A JAIL SENTENCE OF UP TO ONE YEAR, A FINE UP TO $6,250, OR BOTH. THIS CERTIFICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

TITLE

PHONE

FAX

SIGNATURE (FAXED SIGNATURES ARE ACCEPTABLE)

PRINT NAME

DATE

FORM 735-9685 (1-14)