FMCSA Form OCE-46
FMCSA Form OCE-46
Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this
form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire.
For questions, please contact the Office of Registration, Registration Division.
A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current
valid OMB Control Number. The OMB Control Number for this information collection is 2126-0018. Public reporting for this collection of information
is estimated to be approximately 15 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and
reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.
FORM OCE-46
Docket Number: 1714169 Name of carrier, freight forwarder, or broker making request:
For the reasons stated below, this carrier, freight forwarder, or broker, which is the holder of the above-identified permit(s), certificate(s),
or license(s), hereby requests revocation of such registration to the extent specified, in accordance with the provisions of 49 U.S.C. 13905.
Please select authority type (check all that apply): Common Contract ✔ Broker
Reason for request of revocation: Broker authority was added by mistake, but the client is only a motor carrier.
It is clearly understood that upon revocation of this registration, operations that are revoked may not be resumed unless this authority is
reinstated or other registration has been issued.
Name of person authorized
to submit this request
(please type or print): Daytime telephone number:
Signature of person
authorized to submit
this request: Date: / /
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Note: Signature must be notarized or signed in the presence of a FMCSA staff member.
City/County: State/Province:
YT
WY
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WI
WA
VT
VI
VA
UT
TX
TN
SK
SD
SC
RI
QC
PW
PR
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PA
OR
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NS
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NH
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ME
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MB
MA
LA
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IN
IL
ID
IA
HI
GU
GA
FM
FL
DE
DC
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CO
CA
BC
AZ
AS
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AL
AK
AB
Subscribed and sworn to before me this day of ,
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Notary Signature:
Please return Form OCE-46, Request for Revocation of Authority Granted, to: