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BMV 4535 11/09
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
TRIP PERMIT AGENCY WEEKLY SALES REPORT
PLEASE TYPE OR PRINT LEGIBLY
DATE
AGENTS NAME
AGENTS NUMBER
BUSINESS ADDRESS
CITY
STATE
ZIP CODE
PLEASE NOTE: Your agency’s trip permit records will be audited on a regular basis to ensure compliance with
BMV rules and contractual obligations.
WEEKLY SALES REPORTING GUIDELINES
1. 72 hour permits issued must be reported on the first working day of the week following the date of issuance.
2. All Trip Permit Applications (BMV 5765) must be issued and reported in consecutive order, and an accurate list of all
trip permits issued must be maintained.
3. Copies of all trip permits issued by your agency must be retained in your files for three years.
4. Trip permits may not be reissued.
5. Trip permits are assigned to your agency. Do not give or transfer permits to any other agency.
6. BMV issued form must be returned to BMV if permit is issued electronically.
LIST ALL 72 HOUR TRIP PERMITS ISSUED IN THE SPACE BELOW:
1. 2. 3. 4.
5. 6. 7. 8.
9. 10. 11. 12.
13. 14. 15. 16.
17. 18. 19. 20.
21. 22. 23. 24.
LIST ALL VOIDED 72 HOUR TRIP PERMITS IN THE SPACE BELOW:
1. 2. 3. 4.
5. 6. 7. 8.
SIGNATURE OF AGENT/AGENT’S REPRESENTATIVE
X
DATE
All Voided Trip Permits Must Be Returned With This Form
Do not fax. Please mail to:
Ohio Bureau of Motor Vehicles
ATTN: IRP Trip Permits Coordinator
P.O. Box 16521
Columbus, Ohio 43216-6521