Annual Toll Road Gate Application {M-233T}

Form M-233T State Form 2331 (R4/ 6-06) Indiana Department of Revenue Annual Toll Road Gate Application A. STARTING DATE: JANUARY 1, _____ B. EXPIRATION DATE: DECEMBER 31, ____ FEE: $20.00 PER GATE (1) Name of Transporting Company: (3) Federal Identification Number: Address: (4) Social Security Number (If Sole Proprietor): City, State, and Zip: (5) Make of Tractor: Daytime Telephone Number: (2) Contact Person (6) Vehicle Identification Number (VIN): (7) Toll Road Gate Numbers ALLOWABLE WEIGHTS: A single axle must not exceed 22,400 pounds per axle; each axle of a tandem group may not exceed 18,000 pounds per axle; and the weight per inch width of tire measured between flanges of the rim may not exceed 800 pounds. ALLOWABLE DIMENSIONS: The category checked below applies to this permitted vehicle and load. 1 2 A single vehicle whose width does not exceed 12 feet, the length does not exceed 65 feet, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits, may not exceed 90,000 pounds. A combination of two vehicles (tractor-trailer) whose trailer does not exceed 53 feet in length, the width of which does not exceed 12 feet, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits, may not exceed 90,000 pounds. A combination of three vehicles (tractor-trailer-trailer) whose trailers do not exceed 48 feet, 6 inches each, the width of which does not exceed 8 feet, 6 inches, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits, may not exceed 127,400 pounds. CAUTION: You must contact the Indiana Toll Road Authority to obtain a toll road certification for this type of vehicle prior to applying for this permit. 3 A combination of 4 vehicles (tractor and triple trailer) whose trailers do not exceed 28 feet, 6 inches each, the width of which does not exceed 8 feet, 6 inches, and the height does not exceed 13 feet, 6 inches. The maximum weight, subject to axle limits, may not exceed 127,400 pounds. CAUTION: This type of triple trailer combination is not allowed on any highway other than an Indiana toll road, except between an Indiana toll road designated make-up, break-up area and the nearest toll gate. 4 The General Provisions and any Special Provisions, are incorporated by reference into the permit and are as fully binding upon the permittee as if they had appeared on the face of the permit. THE PERMIT IS VALID OVER STATE ROADS: All state highways, when used in conjunction with toll road travel, within 15 miles to or from the permitted Toll Gate (permits are Gate specific), but excluding: all Interstate Highways and Indiana Harbor Canal Lift Bridges. The permit is NOT valid with a special weight permit. Special Gate Exceptions GATE 101: Excluding any vehicle with an overall length in excess of 95 feet. GATE 144: Excluding State Road 1 and State Road 427. Under penalties of perjury, I declare I have examined the above information, and to the best of my knowledge and belief it is true, correct and complete. Signature Date American LegalNet, Inc. www.FormsWorkflow.com FORM M-233T INDIANA TOLL ROAD GATE PERMIT Revision Narrative Once the annual Toll Road Gate Permit Application is completed, a permit request form is completed by the taxpayer. The requested number of Permits (this form, M-233T) are then sent to the taxpayer. One permit, per vehicle, per gate, is issued based upon their request. The permit is actually completed by the taxpayer. Significant changes were made to the form. The first was the deletion of the paragraph that reiterates the language of the Toll Road Gate Permit Application. A perjury statement was added and a reference to the Toll Road Gate Permit Application was added. The second major change was the addition and clarification of the types of vehicle combinations that may be permitted, based upon the dimensions. These changes were made possible with the assistance of Sam Wolfe of the Toll Road Division of the INDOT. (Common enforcement problems included vehicles that fit the "general limits" previously stated on the permit, but exceeded the limits per type of vehicle.) These changes should help educate the taxpayer, better facilitate the permitting process, and complement enforcement activities. The following list summarizes the other changes that were made. (1) IDR replaces INDOT in the title. (2) The portions that the taxpayer completes (1 through 7) were grouped together so that when the annual letter is mailed with instructions, the taxpayer may follow along more easily. (3) A space for the gate number was added since the taxpayer was instructed to "place it anywhere" in the past. (4) The serial number (item 4) was redesigned to accommodate the last five digits of the VIN. (This was identified as a common error by the taxpayer.) (5) The provisions on the face of the permit were modified to more closely resemble the statutory language of IC 9-20-6-3. The 4th General Provision on the back of the form was changed to reflect any authorized employee of the State of Indiana, rather than just the Department of Transportation. (6) (7) The "Notice to Police" was changed to "Notice to Enforcement Personnel" and the verbiage was also modified in the same paragraph. (8) The mailing address was changed to PO Box 6175 (share with IFTA). (9) A statement alerting the taxpayer to request a signature addendum, if needed, was added. This is in re sponse to a recent citation. (The addendum is generic and may be used for any type of permit.) See also: M-207, Annual Toll Road Gate Application M-209, Permit Request for Toll Road Gates & Guidelines American LegalNet, Inc. www.FormsWorkflow.com (10) Added lines for the year at the top of form for starting date and expiration date. Also, changed phone numbers in instructions to new location. November, 2002 1)In box 3 and 4 notified carrier to obtain a toll road certification prior to applying for these types of permits. January, 2004 1) Line 12 of the instructions the line reading "A duplicate of the permit is not valid for purpose of any movements was removed per Corina. August, 2004 As of the first of 2005, this form may be processed through Motor Carrier computer system. January, 2005 Deleting Annual Permit Number and adding Federal Identification Number. Adding penalty of perjury statement at the bottom with signature and removing current perjury statement. These changes are for when the forms are processed through Motor Car