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Employer Company Name Form DOT F 1385 Rev. 5/2008 Doing Business As DBA Name if applicable Address E-mail Name of Certifying Official Signature Telephone Date Certified Prepared by if different Telephone C/TPA Name and Telephone if applicable Check the DOT agency for which you are reporting MIS data and complete the information on that same line as appropriate FMCSA Motor Carrier DOT Owner-operator circle one YES or NO Exempt Circle One YES or NO FAA Aviation Certificate if applicable...
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