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2. 
3. Wyoming County Highway Department

   4328 State Route 19, Silver Springs, NY 14550

   Phone (585)786-8955        Fax (585)786-3297

                  Devin Blue - Superintendent

5. Company Name*
6. Date of Application*
   Date of Application
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address
17. Contact Person/Signature*
    By electronically signing this form you agree to this authorization.
19. Total dollar amount mailed (if applying by mail)
    NOTE: Form may be printed and mailed to our offices at Wyoming County Highway Department: 4328 State Route 19, Silver Springs, NY 14550 with appropriate payment fee.
    
    COST: $25.00 per permit prior to issuing Wyoming County Divisible Load Permit. Make check payable to Wyoming County Highway Department. If applying by mail, please include a copy of each truck's current registration and current NYSDOT Divisible Load Permit.
    
    Please note that this permit will expire at the same time that the NYSDOT Divisible Load Permit expires.
21. OR to apply online and pay now
    Click here to pay online with GovPay

    Please pay amount associated with 'Reason for Permit' field that was selected.
    PLEASE NOTE: Upon successful payment thru GovPay please submit application for review using the 'Submit' button or the 'Submit and Print' button
23. Truck Registration
    Please attach an electronic copy of the truck's current registration
24. NYSDOT Divisible Load Permit
    Please attach an electronic copy of the current NYSDOT Divisible Load Permit
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit Submit and Print

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