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Click ‘Get Form’ to open it in the editor.
Begin with Section I, entering your Tire Dealer/Generator Information. Fill in your name, recycling fee account number, street address, city, county, sales tax permit number, and phone number. Ensure all details are accurate before proceeding.
Next, specify the quantities of tires you are reporting under the respective categories (motorcycle tires, automobile tires, etc.). This section is crucial for compliance.
Complete the certification statement by printing your name and signing it. Don’t forget to date the form.
Move on to Section II for Hauler Information. Repeat similar steps as in Section I: provide necessary details and certifications.
Continue with Section III for Recipient Information. Fill out all required fields and ensure that the recipient certifies the information provided.
If applicable, complete Section IV regarding Tires Culled for Resale. Follow the same process of filling out details and certifications.

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