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Zip Code Mailing Street Address Mailing City SECTION 2. CLASSIFICATION Check All That Apply Motor Carrier Motor Private Carrier SECTION 3. VEHICLES USED EXCLUSIVELY IN INTRASTATE TRANSPORTATION The above described carrier hereby declares that the following vehicles are used exclusively for intrastate transportation of property, waste, or recyclable material: MAKE MODEL LICENSE PLATE VIN NUMBER NUMBER/STATE Use reverse side if needed. Carriers may also submit the requested data in electro.

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