MOTOR CARRIER PERMIT APPLICATION INSTRUCTIONS
Effective January 1, 2016.
If you need a Motor Carrier Permit (MCP) Let us know and we can steer you in the right direction- it can be a little confusing but we know where to go and what to do.
All Motor Carrier Permit (MCP) applicants must complete this application, in its entirety, pay the required fees, provide required information regarding enrollment in mandated programs, provide and maintain liability insurance at the required level on the required form, and provide workers’ compensation insurance on the required form if you are subject to California’s workers’ compensation laws.
Effective January 1, 2016, the Department of Motor Vehicles (DMV) will begin collecting the Carrier Inspection Fee (CIF) in conjunction with the base fees upon original application and renewal of an MCP, per Revenue and Taxation Code (R&TC) Sections 7236 (a) (1) and (2) (B). Base fees include the Safety Fee and Uniform Business License Tax (UBLT). The CIF replaces the Biennial Inspection of Terminal fees. The CIF will not be apportioned or prorated. R&TC Section 7236 (d) requires DMV to assess delinquency fees for late payment of fees due. Delinquency fees will continue to accrue until ALL
fees are paid and ALL fees must be paid to obtain an MCP. Under the new Basic Inspection of Terminals (BIT) program, the California Highway Patrol (CHP) will select terminals for inspection based on available carrier performance data or the commodity transported, rather than the prior time-based mandate of once every 25 months.
If you need forms, have questions, or need assistance completing this application, information is available athttp://www.dmv.ca.gov/mcs/mcs_permits.htm or call (916) 657-8153.
Make a copy for your records then mail the signed, completed application to the address provided in SECTION 15. Required information must be provided or your application will be returned. CARRIER IDENTIFICATION NUMBER (CA#):
your area for assistance.
SECTION 1 – TYPE OF APPLICATION: check only one box
A. ORIGINAL –
B. REINSTATEMENT – You are reinstating your MCP after a Voluntary Withdrawal, Suspension, or Revocation.
C. RENEWAL – You are renewing your MCP.
D. SEASONAL ORIGINAL/RENEWAL –
expired. Seasonal MCPs are issued for no less than 6-months and no more than 11-months during your 12-month
permit term. Seasonal MCPs are not issued to interstate motor carriers.
E. SEASONAL EXTENSION – You are adding months to an existing seasonal MCP (11-months maximum in the 12-month
SECTION 2 – LEGAL NAME/BUSINESS ENTITY: check only one box and enter the required information
A. INDIVIDUAL – An individual operating as a sole proprietor must provide:
Full legal name (use the same name as shown on your driver license), your driver license number, and the state of
issuance.
B. CORPORATION –
Tribe, or a Government Agency must provide:
“EXEMPT”.*
Corporation number issued by the Secretary of State, state of issuance, and date of incorporation.
C. LIMITED LIABILITY COMPANY (LLC) – An LLC registered with the Secretary of State must provide:
D. PARTNERSHIP –
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*NOTE
TELEPHONE NUMBER: required information – Provide the business telephone number or the application will be returned.
AUTHORIZED REPRESENTATIVE: Required if an Authorized Representative signs the application – Enter the name
SECTION 3 – DOING BUSINESS AS (DBA)/TRADE NAMES/FICTITIOUS BUSINESS NAMES:
You are required
Do not include DBA names unless they are adopted in compliance with the Business and Professions Code, commencing
SECTION 4 – PRINCIPAL PLACE OF BUSINESS: required information
A. Business Address –
B. Mailing Address (If Different) – Enter the mailing address if it is different than your business address.
SECTION 5 – TRANSPORTATION ACTIVITIES: check all that apply
Select all Transportation Activity boxes that apply to your motor carrier operation. You are required to provide this
information in full.
SECTION 6 – TYPE OF VEHICLE(S): check all that apply
Select all boxes that describe the type(s) of vehicle(s) used in your motor carrier operation. You are required to provide this
information in full.
SECTION 7 – OPERATING AUTHORITY IDENTIFICATION NUMBERS: check only one box
If you operate intrastate only, select the Intrastate box and continue to SECTION 8. If you operate interstate, you must
complete this section in full. Select the Interstate box and:
Enter your total interstate miles (this includes California mileage). If you are a new business without prior operations,
you may estimate your mileage.
Certify awareness of Federal Motor Carrier Safety Regulations and/or Federal Hazardous Materials Regulations.
http://www.ucr.in.gov/.
NOTE: All interstate motor carriers are subject to the UCR Act of 2005 and must register with UCR prior to issuance of the
MCP. UCR fees are due annually by January 1.
SECTION 8 – CONTROLLED SUBSTANCE AND ALCOHOL TESTING (CSAT): required information
All motor carrier permit holders are required to certify enrollment in a CSAT program that meets USDOT rules for commercial
drivers, unless otherwise exempted.
A. Enrolled in CSAT – Select this box if you are required to be enrolled in a CSAT program pursuant to CVC Section
34520.
Exempt from CSAT – Select this box if you are exempt from enrollment.
If you are not sure whether you are required to be enrolled in a CSAT program, contact the CHP Motor Carrier Safety Unit
in your area for assistance or visit http://www.chp.ca.gov.
SECTION 9 – EMPLOYER PULL NOTICE PROGRAM (EPN): check only one box
If vehicles used in your motor carrier operation require the driver to hold a Commercial Driver License (class
http://www.dmv.ca.gov/ vehindustry/epn/epngeninfo.htm or call (916) 657-6346 for assistance.
Select one of the following:
A. EPN Number Required –
Your business entity is a Corporation, LLC, Partnership, or Individual; one or more commercial vehicles in
family, or your vehicles are operated by members of the Corporation, LLC, or Partnership.
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Your business entity is Individual
that requires the driver to hold a Commercial Driver License.
B. Owner Operator – Select this box when:
Your business entity is Individual
driver to hold a Commercial Driver License and no more than three trailers. The department will enroll you in its
department may suspend your motor carrier permit.
NOTE: The Owner Operator selection is only for business entity Individual who meets the definition of an Owner Operator
and is not an applicable selection for business entity Corporation, LLC, or Partnership.
C. EPN# Not Required – Select this box and enter the requested information when:
Your motor carrier operation does not require drivers to hold a Commercial Driver License.
You do not have a terminal (place of business) located within California. Enter out-of-state business address.
Your motor carrier operation requires drivers to hold a Commercial Driver License, however, you do not employ the
account. Enter the name, address, and telephone number of the agency or third party.
NOTE
information needed, you will be notified in writing.
SECTION 10 – VEHICLES OPERATED: must be completed in full
A For-Hire motor carrier is one who transports property for compensation. A Private motor carrier is one who transports
only their own property, including, but not limited to, the delivery of goods sold by that carrier. If you use vehicles both For-
Hire and Private operation, enter that information in the corresponding section.
A. Number of Vehicles – You are required to provide:
The number of motor vehicles used in your motor carrier operation.
Indicate if the motor vehicles are used For-Hire (includes seasonal) or Private, or both.
B. Vehicle Information – You are required to provide a list of all motor vehicles used in your motor carrier operation by:
License plate number and state issued.
NOTE: Use the format shown on the application. Attach a separate sheet if necessary or you may submit a CD.
SECTION 11 – EMPLOYEES: required for renewal or reinstatement applicants only
annual salary of all employees and owner-operator drivers hired or engaged during the reporting period (CVC Section
34633). Please provide the salary information in $5,000 increments (e.g., $5,000 – $10,000, $15,000 – $20,000), using the
format shown on the application.
SECTION 12 – WORKERS’ COMPENSATION INSURANCE EXEMPTION CERTIFICATION:
All motor carriers are required to provide proof of compliance with California workers’ compensation laws. If you do not
employ any person(s) in your motor carrier operations that would subject you to these laws you may so certify. If you
acceptable proof of insurance. (California Code of Regulations, Title 13, Section 220.16(c)) Submit one of the following
forms as proof of compliance or certify on the application that you are not subject to California workers’ compensation laws.
Acceptable forms of proof are:
Certify by checking the box on the application that you are not subject to the workers’ compensation laws of the
State of California.
NOTE: Proof of insurance must be issued in the same motor carrier legal name entered in SECTION 2 of the application.
SECTION 13 – FEE CALCULATIONS:
Use these charts to determine fees due. For an original Interstate motor carrier, use the following equation:
Divide the intrastate miles by the interstate miles reported in SECTION 7 of the application (you will obtain a
percentage amount).
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Multiply the full year fee amount by the percentage amount to arrive at the total prorated fee.
SECTION 14 – REGISTRATION SERVICE INFORMATION:
As of January 1, 2006, any person or registration service submitting documents and or fees for pay or compensation shall
be licensed by the DMV. The following information is required if you are a registration service:
Printed name and signature of the preparer and date signed.
SECTION 15 – CERTIFICATION
Representative section in SECTION 2 must be completed.
LIABILITY INSURANCE REQUIREMENTS:
Use this chart to determine the level of liability insurance your operation requires based upon the Transportation Activities
you marked in SECTION 5 of the application. Activity B can qualify under any of the insurance limits depending on the type
of property transported and the Gross Vehicle Weight Rating (GVWR) of the vehicle(s).
If you are transporting…
Then you are required to provide
insurance at the following
combined single limit…
or less $300,000
or more $750,000
$1,000,000
Oil listed in Section 172.101 of Title 49, Code of Federal Regulations
Materials Table) $1,000,000
$1,000,000
Petroleum products in bulk including waste petroleum and waste petroleum products $1,200,000
Code of Federal
Regulations, in cargo tanks, portable tanks, and hopper vehicles in excess of 3,500
water gallon capacity
$5,000,000
Division 2.1 or 2.2 gases in cargo tanks or portable tanks in excess of 3,500 water
gallon capacity $5,000,000
$5,000,000
Any quantity of Division 1.1, 1.2, or 1.3 explosives $5,000,000
A permit will not be issued until acceptable proof of liability insurance has been provided to the department. During an
required levels of coverage. Liability insurance must be submitted on one of the following documents:
Surety Bond (MC 55 M)
NOTE: Proof of insurance must be issued in the same motor carrier legal name entered in SECTION 2 of the application.
VOLUNTARY WITHDRAWAL
If you wish to cease motor carrier operations, you must complete and submit a
Request for Voluntary Withdrawal (MC 716 M) prior to cancelling your liability or workers’ compensation insurance.
If you have any questions, call (916) 657-8153.
Mail your completed application to:
DEPARTMENT OF MOTOR VEHICLES
REGISTRATION OPERATIONS DIVISION MS H875
P.O. BOX 932370
SACRAMENTO CA 94232-3700
OR
Overnight Mail to:
DEPARTMENT OF MOTOR VEHICLES
REGISTRATION OPERATIONS DIVISION MS H875
2415 1ST AVENUE
SACRAMENTO CA 95818
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The information required on this form pertains to eligibility for issuance of a Motor Carrier Permit (MCP) and is required
under authority of Division 14.85 of the California Vehicle Code (CVC). Failure to provide the information required under
CVC Section 34621 is cause for refusal to issue an MCP.
The information provided on this form is public record regularly used by law enforcement agencies and is open to
Please read the instructions before completing this application.
NOTE
Department of Motor Vehicles (DMV). Motor carriers are required to pay their state tax obligation. If the state tax
obligation is not paid, DMV may suspend an MCP pursuant to the Business and Professions Code Section 494.5.
SECTION 1: TYPE OF APPLICATION
A. Original
B. Reinstatement
C. Renewal
D. Seasonal Original/Renewal: Select 6 to 11 months in the 12 month term.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Dec
E. Seasonal Extension: Select additional months – no more than 11 months per term.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Dec
SECTION 2: LEGAL NAME/BUSINESS ENTITY – check only one box and complete in full
A. INDIVIDUAL
LAST, FIRST, MI AS SHOWN ON YOUR DRIVER LICENSE OR IDENTIFICATION CARD) STATE ISSUED
B. CORPORATION
AS REGISTERED WITH THE SECRETARY OF STATE) FEIN
STATE ISSUED MONTH/DAY/YEAR)
LAST, FIRST, MI) TITLE
CORPORATE OFFICERS (ATTACH A SEPARATE SHEET IF NECESSARY)
C. LIMITED LIABILITY COMPANY (LLC)
AS REGISTERED WITH THE SECRETARY OF STATE) FEIN
LAST, FIRST, MI) ATTACH A SEPARATE SHEET IF NECESSARY)
D. PARTNERSHIP
FEIN
LAST, FIRST, MI) ATTACH A SEPARATE SHEET, IF NECESSARY)
TELEPHONE NUMBER –
(required for all applicants)
AUTHORIZED REPRESENTATIVE –
(required if authorized representative signs the application)
( )
SECTION 3: DOING BUSINESS AS (DBA)/TRADE NAMES/FICTITIOUS BUSINESS NAMES – enter only legally adopted
CARRIER IDENTIFICATION NUMBER (CA) # APPLICATION FOR
MOTOR CARRIER PERMIT
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CA #
SECTION 4: PRINCIPAL PLACE OF BUSINESS – must be completed in full
PHYSICAL ADDRESS NOT P.O. BOX OR PMB)
A.
CITY STATE
IF DIFFERENT FROM BUSINESS ADDRESS)
B.
CITY STATE
SECTION 5: TRANSPORTATION ACTIVITIES – check ALL boxes that apply (Required)
A. United States (US) Mail. A motor carrier permit is not required if you are contracted exclusively with the US Postal
Service to transport mail.
B. Property under contract with the US Government (other than US Mail).
You must also mark at least one of the following boxes: C, D, E, F, G, H, I, T, U, or V.
C.
D.
You must also mark at least one of the following boxes: E, F, G, H, I, or T and SECTION 6, box I.
E. Oil listed in Section 172.101 of Title 49, Code of Federal Regulations (CFR), but not included in boxes G or H.
F. California Health & Safety Code and Section 66261.1 of
Title 22, California Code of Regulations, but not included in boxes G or H.
G.
transported in cargo tanks, portable tanks, or hopper-type vehicles with capacities in excess of 3,500 water gallons.
H. Any quantity of Division 1.1, 1.2, or 1.3 explosives; any quantity of poison gas (poison A); or highway route controlled
I.
T. Petroleum products in bulk, including waste petroleum and waste petroleum products.
U. Vehicles 10,001 lbs. or more Gross Vehicle Weight Rating (GVWR), transporting property other than that listed
in boxes E, F, G, H, I, or T.
V. Vehicles 10,000 lbs. or less GVWR, transporting property other than that listed in boxes E, F, G, H, I, or T.
SECTION 6: TYPE OF VEHICLE(S) – check ALL boxes that apply (Required)
A. Any motor vehicle used to transport property for-hire or compensation.
B. Motortrucks of two or more axles that are 10,001 lbs. or more GVWR (except a pickup used non-commercially).
C. Motortrucks of three or more axles that are 10,001 lbs. or more GVWR.
D. Truck tractors.
NOTE: Motortrucks or two-axle truck tractors with a GVWR less than 26,001 lbs. are NOT subject to MCP
requirements when operated singly in noncommercial use (provision operative January 1, 2016).
G. Any combination of a motortruck and any vehicle(s) exceeding 40 ft. in length when coupled together, where the
truck is 10,000 lbs. or less GVWR
coaches, and trailers used to transport a watercraft.
H. Any combination of a motortruck and any vehicle(s) exceeding 40 ft. in length when coupled together, where the
truck is 10,001 lbs. or more GVWR
trailer coaches, and trailers used to transport a watercraft.
I.
(See SECTION 5, box D)
J. Any commercial motor vehicle 26,001 lbs. or more GVWR.
K. Any commercial motor vehicle with any GVWR towing any vehicle that is 10,001 lbs. or more GVWR except
combinations including camp and utility trailers, trailer coaches, and trailers used to transport a watercraft.
L.
Motor Carrier Safety Administration (FMCSA) related to hours of service and driver’s logbooks.
M. Motor vehicles with a GVWR of 10,000 lbs. or less.
NOTE: Pickup trucks as defined in CVC Section 471 are subject to MCP requirements when operated in commercial use.
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CA #
SECTION 7: OPERATING AUTHORITY IDENTIFICATION NUMBERS – must be completed in full
INTRASTATE , if applicable. Proceed to SECTION 8.
INTERSTATE – Complete SECTION 7 in full.
Current Unified Carrier Registration (UCR) Authority? (Required) Yes No,
Please pay fees online at http://www.ucr.in.gov.
I certify I am aware of Federal Motor Carrier Safety Regulations and/or Federal Hazardous Materials Regulations.
USDOT # MC # MX #
International Fuel Tax Agreement (IFTA) # International Registration Plan (IRP) #
MILEAGE INFORMATION (REQUIRED) – ENTER:
Total California intrastate fleet miles traveled during the permit period
Total interstate fleet miles (including California miles) traveled during the permit period
Use this mileage information in SECTION 13 for original permits with interstate operations.
NOTE: If this is a new business without prior operations you may estimate mileage. Motor carriers operating both intrastate
SECTION 8: CONTROLLED SUBSTANCE AND ALCOHOL TESTING (CSAT) – must select applicable box
Are you enrolled in or exempt from a CSAT program?
(This is a drug and alcohol testing program that meets USDOT rules
for commercial drivers.)
Enrolled in CSAT Exempt from CSAT
NOTE: If you have questions regarding CSAT, contact the CHP Motor Carrier Safety Unit in your area.
SECTION 9: EMPLOYER PULL NOTICE PROGRAM (EPN) CVC SECTION 1808.1. – must be completed in full
A. EPN# REQUIRED – You are a Corporation, LLC, or Partnership, and your motor carrier operation requires drivers
to hold a Commercial Driver License or you employ drivers, use friends or family, or the vehicles are operated by
members of your entity. You are an individual who has two or more vehicles and at least one of your vehicles requires
the driver to hold a Commercial Driver License. EPN Requester Code # .
B. Owner Operator – You are an Individual who has one vehicle which requires a Commercial Class A, Commercial
Corporations, LLCs, or Partnerships).
C. EPN# NOT Required – Provide the required information below.
Motor carrier operation does not require a Commercial Driver License.
Motor carrier operation requires a Commercial Driver License and I obtain drivers from a third party (enter name,
address, and telephone number)
NOTE:
you will be notified in writing.
SECTION 10: VEHICLES OPERATED – must be completed in full
A. Enter the number of vehicles owned, registered, leased, and/or operated during the last permit period. If this is a new
business without prior operation or permits, enter the number of vehicles that will be operated during the current permit
period. If you have vehicles that are For-Hire and Private, enter those numbers where appropriate. Do not include
trailers.
NUMBER OF VEHICLES – For-hire or seasonal (transport property for compensation)
NUMBER OF VEHICLES – Private (transport your own property)
TOTAL NUMBER OF VEHICLES IN FLEET
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CA #
B.
sheet of paper or CD using the format shown below, including your CA# and business name. Do not include trailers.
LICENSE PLATE NUMBER STATE ISSUED VEHICLE IDENTIFICATION NUMBER
SECTION 11: EMPLOYEES – required from renewal and reinstatement applicants with 20 or more vehicles only
20
and owner-operator drivers hired or engaged during the reporting period. If necessary, submit this information on a separate
sheet of paper or CD using the format in the example shown below. Include your CA# and business name.
NUMBER OF
EMPLOYEES CLASSIFICATION
GROSS
ANNUAL
SALARY
NUMBER OF
EMPLOYEES CLASSIFICATION GROSS ANNUAL
SALARY
Example: 25 Drivers $65,000-$70,000 Example: 5 Mechanics $70,000-$75,000
TOTAL NUMBER OF EMPLOYEES:
SECTION 12: WORKERS’ COMPENSATION INSURANCE EXEMPTION CERTIFICATION
If you are not subject to the workers’ compensation laws of California, certify by checking the box below. No
I certify that I do not employ any person(s) in any manner so as to become subject to the workers’ compensation laws
of California.
If you employ any person(s) in your motor carrier operations that subject you to the workers’ compensation laws
NOTE: Proof of insurance must be issued in the same motor carrier legal name entered in SECTION 2 of the application.
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**Base Fees include the Safety Fee and UBLT
FULL YEAR ORIGINAL INTERSTATE CARRIER (COMBINED CARRIER):
Following the instructions for Full Year Intrastate Carriers (above), enter the Base Fee amount due
…………………… A. $
…………………………………………………………………………………… B.
……………………………………………………….C.
Divide the number in B by the number in C and enter it here ……………………………………………………………. D. %
Multiply the amount in A by the percentage in D and enter it here …………………………………………………….. E. $
here ………………………………………………………………………………………………………………………………………….. F. $
…………………………………..G. $
FEE CALCULATIONS – INTRASTATE SEASONAL – FOLLOW THE STEPS BELOW
The minimum Seasonal permit period allowed is 6-months and the maximum period is 11-months in your twelve month term.
The Seasonal permit may be extended for additional months beyond those indicated on the Original/Renewal application
within the twelve month term. For each extension request, a $5 Extension Request Fee is required along with the Per-Month
Extension Fee, per Revenue & Taxation Code, Section 7236(c)(1).
SEASONAL ORIGINAL/RENEWAL:
Use the chart on the next page to identify the Total Amount Due.
CA #
SECTION 13: FEE CALCULATION CHART – interstate and intrastate full year – follow the steps below
FULL YEAR INTRASTATE CARRIERS (DOING BUSINESS IN CALIFORNIA ONLY):
Use the chart that applies to your operation (For-Hire and/or Private
Enter it in the total amount due. If you have vehicles that are For-Hire and Private, add both fees to obtain the total amount due.
FEE CHART – FULL YEAR INTRASTATE CARRIERS* (DOING BUSINESS IN CALIFORNIA ONLY)
*Interstate carriers
The CIF is due in full for all carriers and will not be apportioned or prorated.
FLEET SIZE
FOR HIRE PRIVATE
BASE FEES** CIF TOTAL BASE FEES** CIF TOTAL
1 $120 $130 $250 $35 $130 $165
2-4 $200 $152 $352 $35 $152 $187
5-10 $475 $252 $727 $35 $252 $287
11-20 $710 $573 $1,283 $240 $573 $813
21-35 $975 $743 $1,718 $325 $743 $1,068
36-50 $1,310 $961 $2,271 $430 $961 $1,391
51-100 $1,610 $1,112 $2,722 $535 $1,112 $1,647
101-200 $1,935 $1,463 $3,398 $635 $1,463 $2,098
201-500 $2,240 $1,512 $3,752 $730 $1,512 $2,242
501-1000 $2,545 $1,600 $4,145 $830 $1,600 $2,430
1001-2000 $2,830 $1,800 $4,630 $930 $1,800 $2,730
2001 & Above $3,030 $2,114 $5,144 $1,030 $2,114 $3,144
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CA #
SEASONAL EXTENSION:
Locate the Per Month Extension Fee
Multiply the Per Month Extension Fee by the number of months the permit is being extended to obtain your subtotal.
Add the $5.00 Extension Request Fee to the subtotal to obtain the Total Amount Due for a Seasonal extension permit.
FLEET SIZE CIF+ 6
MONTHS
7
MONTHS
8
MONTHS
9
MONTHS
10
MONTHS
11
MONTHS
EXTENSION
REQUEST FEE
PER MONTH
EXTENSION FEE
1 $130 $90 $95 $100 $105 $110 $115 $5 $5
2-4 $152 $141 $152 $163 $174 $185 $196 $5 $11
5-10 $252 $338 $361 $384 $407 $430 $453 $5 $23
11-20 $573 $480 $520 $560 $600 $640 $680 $5 $40
21-35 $743 $655 $710 $765 $820 $875 $930 $5 $55
36-50 $961 $874 $948 $1,022 $1,096 $1,170 $1,244 $5 $74
51-100 $1,112 $1,075 $1,165 $1,255 $1,345 $1,435 $1,525 $5 $90
101-200 $1,463 $1,289 $1,398 $1,507 $1,616 $1,725 $1,834 $5 $109
201-500 $1,512 $1,486 $1,612 $1,738 $1,864 $1,990 $2,116 $5 $126
501-1000 $1,600 $1,688 $1,831 $1,974 $2,117 $2,260 $2,403 $5 $143
1001-2000 $1,800 $1,884 $2,043 $2,202 $2,361 $2,520 $2,679 $5 $159
2001 & Above $2,114 $2,032 $2,199 $2,366 $2,533 $2,700 $2,867 $5 $167
FEE CHART – SEASONAL CARRIERS
Seasonal carriers (FOR HIRE only) are required to pay the CIF in full, but only once, upon commencement of the seasonal
NOTE: A seasonal MCP is not issued to INTERSTATE motor carriers.
SECTION 14: REGISTRATION SERVICE INFORMATION – for Registration Service Use only
X
( )
DATE
SECTION 15: CERTIFICATION – complete and sign
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true
and correct.
TITLE
X
CITY) DATE
PAYMENT:
Make your check or money order (NO CASH) payable to the Department of Motor Vehicles and submit with your application.
Call (916) 657-8153 if you have any questions.
NOTE: If the bank does not honor your payment, a $30 dishonored check fee will be assessed and your permit may be
cancelled.
Mail your completed application to:
DEPARTMENT OF MOTOR VEHICLES
REGISTRATION OPERATIONS DIVISION MS H875
P.O. BOX 932370
SACRAMENTO CA 94232-3700
OR
Overnight Mail to:
DEPARTMENT OF MOTOR VEHICLES
REGISTRATION OPERATIONS DIVISION MS H875
2415 1ST AVENUE
SACRAMENTO CA 95818
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