AUTHORITY NO.
NAME
NAME
ADDRESS
ADDRESS
CITY
ST
ZIP CODE
CITY
ST
ZIP CODE
SIGNATURE
TELEPHONE NO.
TELEPHONE NO.
SIGNATURE
FORM 735-9084 (6-02)
STK# 320097
OREGON DEPARTMENT OF TRANSPORTATION
MOTOR CARRIER TRANSPORTATION DIVISION
550 CAPITOL ST NE
SALEM OR 97301-2530
After completing this form, return it to the Oregon Department of Transportation at the address above. Attach a separate sheet, if necessary,
to explain fully any of the items 1 through 13 below.
, Lessor,
By this lease agreement
, Lessee,
does hereby lease to
the following described bus, truck or tractor:
Odometer
Reading
Year
Make
ID/Serial #
License #
State
To be used by the lessee (operating carrier) in transporting household goods or passengers in regular route full-service scheduled operations between points
which lessee is lawfully authorized to serve on an intrastate basis within the State of Oregon. The vehicle must be registered under the lessee’s operating
authority by means of either a valid ODOT temporary pass or Oregon Weight Receipt and Tax Identifier.
Additionally, leases are valid only after submission to the Department of Transportation, but the
Yes
No
(a) The lessor is providing a driver to the lessee, who is a for-hire carrier.
(b)
Yes
No
If the answer to (a) and (b) is YES, the driver is included on the payroll of the lessee if the lessor is paid on a division of revenue,
as required by OAR 740-045-0110.
Yes
No
The parties mutually understand and agree as follows:
That the sole possession, responsibility, and control of the vehicle for the entire term of this lease is to reside with the lessee, with the exception that
the lessor may use the leased vehicle for personal noncommercial uses with the permission of the lessee.
1.
That the lessee is solely responsible for the safe operation of the vehicle and the parties agree that the lessee (one of the two boxes must be checked):
2.
Pays for all routine and major maintenance costs on the vehicle during the term of this lease.
Pays for the costs of the following maintenance item