ARIZONA DEPARTMENT OF TRANSPORTATION

ENFORCEMENT & COMPLIANCE DIVISION

1225 N. 25th Avenue
Mail Drop 524M
*88-854352*
Phoenix, AZ 85009 Permit: 88-854352 Revision: 0

SINGLE TRIP REGISTRATION/USE FUEL/MOTOR CARRIER

Eff. Date/Time: 1/19/2023 3:24:00 PM Exp.Date/Time: 1/23/2023 3:24:00 PM or upon exit from the state.
Company/Lessee: PEREZ CARRILLO JESUS PEDRO USDOT: Trailer Nbr: TPC-74
Unit No.: Plate No.: 11AL1B Base State: MX Make: VOLV Body Style: TRK
Veh. Yr.: 2000 VIN: 4V4ND4JH8YN241653 No. of Axles: 5 GVW/GCW: 80000

The Gross Vehicle Weight stated above does not include any additional weight allowed by ARS 28-1100 for Idle Reduction Technology.

By checking the box preceding this statement, the permit holder certifies that the vehicle listed above is equipped with fully
functional Idle Reduction Technology that qualifies for the additional weight allowed by ARS 28-1100.

Insurance Insurance
Permit: 88-854352 Rev.: 0 Policy #:
QAZ-63069-09 Expires:
12/17/2023

Plate: 11AL1B Power Unit: Trailer: TPC-74

Traveling From: Traveling To: Miles:
NOGALES NOGALES 30
Total Miles: 30

Route: LOCAL

The following documentation will be required for entry into Arizona:

Valid driver license

Valid insurance policy with sufficient coverage
Valid registration from base state
Current annual safety inspection

These documents will be verified at the port of entry.

Fees: REGISTRATION $5.00

MOTOR CARRIER $12.00
USE FUEL $16.00
Total Fees: $33.00

Remarks: Received: SUAREZ BROKERAGE $33.00

MEXICO-DOMICILED MOTOR CARRIERS CANNOT CO.
TRAVEL BEYOND THE RECOGNIZED COMMERCIAL Total Received: $33.00
ZONE PERIMETERS WITH THIS PERMIT. Change: $0.00

Notice: This permit is issued for a single trip unless otherwise stated, is valid only on the Total Amount: $33.00
dates and routes shown above, and is subject to all other conditions and details listed
Location: INTERNET
above as well as all the conditions, prohibitions, exclusions, restrictions and exceptions
set forth in Title 28 of the Arizona Revised Statutes and Title 17 of the Arizona Exempt: NO
Administrative Rules. These statutes and rules can be found at www.azdot.gov
Issued Date/Time: