Estimated Miles and First Year Applicants Schedule G

The following form has to be completed and submitted in order to provide an estimated mileage count for a vehicle.

Extracted Text for Proper Search

Department of Highway Safety and Motor Vehicles 
Division of Motorist Services	
 	
Bureau of Commercial Vehicle and 
Driver Services	
 	
 	
 
 
ESTIMATED MILES AND FIRST YEAR APPLICANTS 	
SCHEDULE  G 	 	 
ACCOUNT NAME 	
MAILING ADDRESS 	PHYSICAL ADDRESS 	
ADDRESS ADDRESS
CITY, STATE, ZIP CITY, STATE, ZIP	
TELEPHONE NUMBER 	FEDERAL EMPLOYER IDENTIFICATION NUMBER 	
  
 	 	
1.   Describe how your vehicle(s) is/are currently 
registered, and provide a copy of the vehicle 
registration(s).                           (Check  One) FloridaStraightPlate	
Apportioned Plate
Other	
2.  Have you previously been denied registration?Yes  No  
3.  In the past, have you had IRP registration in Florida?Yes  No  
      If yes, please indicate the name and account number on previous account(s):
 
 
4.  Has your registration ever been suspended or revoked?Yes  No  
5.  Do you hold any type of operating authority? Yes  No  
      If yes, briefly describe:  
 
6.  Are your vehicle(s) presently leased to any individual/company?Yes  No  
      If yes, list the  name and address: 
 
7.  Have your vehicle(s) been previously registered under any other name?Yes  No  
      If yes, list each name and address: 
 
8.  Has any permitting service, remittance agency, trucking service agency, consultant, orother Yes  No  
      individual assisted you in the preparation of your IRP application?
      If yes, list names and addresses: 
 
9.  How did you determine the jurisdictions you choseto apportion with? 
 
 
10. Actual distance is required if you owned or leasedany power unit during the reportingYes  No  
       period identified on the mileage schedule.  Did you accrue actual miles under the IRPduring 
       the reporting period? 
 
11. If you currently have apportioned vehicle plates, or if you had apportioned vehicle plates in the past, why are
       estimated miles being used:  (please explain‐‐attach additional pages, if necessary	)	
 
 
12. Have you ever reported estimated miles in the jurisdiction(s) in which you are requesting? Yes  No   
I (We) hereby affirm that the information set forth herein is true and correct:
  
Authorized Signature                                            Title                                    DateAuthorized Signature                                            Title                                    Date 	HSMV 85046  (6/11)