OMB No.

: 2126-0018  Expiration: 05/31/2014

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.

United States Department of Transportation

Federal Motor Carrier Safety Administration

Office of Registration and Safety Information:

Request for Revocation of Authority Granted

FORM OCE-46
Docket Number: Name of carrier, freight forwarder, or broker making request:

Address of requesting carrier: Street: City:

State: Zip Code:

American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Marshall
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
North
Northern
Puerto
Pennsylvania
Palau
Oregon
Oklahoma
Ohio
Rhode
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
York
Virginia
Carolina
Dakota
Carolina
Dakota
Island
Islands
Rico
ofIslands
Marianas
Samoa
Columbia

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:

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:
American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Marshall
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
North
Northern
Puerto
Pennsylvania
Palau
Oregon
Oklahoma
Ohio
Rhode
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
York
Virginia
Carolina
Dakota
Carolina
Dakota
Island
Islands
Rico
ofIslands
Marianas
Samoa
Columbia
Subscribed and sworn to before me this day of ,
Affix Notary Seal
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1st December
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September
August
July
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Notary Signature:

My commission expires on: / /

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Name/Title of witnessing FMCSA staff member (please type or print):

FMCSA staff member signature: Witnessed on: / /

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FORM OCE-46 Page 1 of 2

 OMB No.: 2126-0018  Expiration: 05/31/2014

Please return Form OCE-46, Request for Revocation of Authority Granted, to:

Federal Motor Carrier Safety Administration

Office of Registration and Safety Information
MC-RS (W63-105)
1200 New Jersey Ave., S.E.
Washington, D.C. 20590
The original form must be submitted. Faxed, E-mailed, or photocopied forms will not be accepted. The attached Form OCE-46,
Request for Revocation of Authority Granted, must be completed in its entirety (docket number/MC, complete name and address of
the carrier, and authorized signature) and notarized, in order that FMCSA may process your request. All questions should be directed
to the Office of Registration and Safety Information at (866) 637-0635.

FORM OCE-46 Page 2 of 2