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Permanent Registration Fee$15.00 DEPARTMENT OF FINANCE Validation No. <br /> VEHICLE REGISTRATION& <br /> Replacement Decal Fee$2.00(Tag No. LICENSING DIVISION H <br /> _Duplicate Registration Fee$5.00 101 PAUAHI STREET,SUITE#5 <br /> HAWAII 96720 <br /> _Transfer Fee$5.00 HILO, PERMANENT <br /> APPLICATION FOR BICYCLE AND MOPED REGISTRATION (NO EXPIRATION) <br /> PRINT CLEARLY IN INK OR TYPE <br /> OWNER PHONE NO. <br /> MAILING ADDRESS <br /> CITY/STATE ZIP CODE <br /> MAKE YEAR MODEL COLOR SERIAL NO. <br /> MEN'S E_] WOMEN'S F__1 SPEED WHEEL SIZE MOPED F__] H.P. <br /> FROM WHOM ACQUIRED DATE ACQUIRED NEW F__j USED <br /> The undersigned,being 18 years of age or older,hereby certifies that the serial number furnished above is the actual number taken <br /> from the bicycle or moped and that the foregoing statements are true to the best of my knowledge and belief. <br /> Date Signature of Owner <br /> If new bicycle or moped purchased locally,dealer must sign below. This application is VRL Use Only <br /> certified true and correct. Date Issued Clerk <br /> By <br /> VRL OFFICE COPY <br /> Hawai'i County is an Equal Opportunity Provider and Employer <br /> _Permanent Registration Fee$15.00 DEPARTMENT OF FINANCE Validation No. <br /> VEHICLE REGISTRATION& <br /> Replacement Decal Fee$2.00(Tag No. LICENSING DIVISION H <br /> -Duplicate Registration Fee$5.00 101 PAUAHI STREET,SUITE#5 <br /> Transfer Fee$5.00 HILO,HAWAII 96720 <br /> — PERMANENT <br /> APPLICATION FOR BICYCLE AND MOPED REGISTRATION (NO EXPIRATION) <br /> PRINT CLEARLY IN INK OR TYPE <br /> OWNER PHONE NO. <br /> MAILING ADDRESS <br /> CITY/STATE ZIP CODE <br /> MAKE YEAR MODEL COLOR SERIAL NO. <br /> MEN'S E-1 WOMEN'S F__j SPEED WHEEL SIZE MOPED F H.P. <br /> FROM WHOM ACQUIRED DATE ACQUIRED NEW F__] USED <br /> The undersigned,being 18 years of age or older,hereby certifies that the serial number furnished above is the actual number taken <br /> from the bicycle or moped and that the foregoing statements are true to the best of my knowledge and belief. <br /> Date Signature of Owner <br /> If new bicycle or moped purchased locally,dealer must sign below. This application is VRL Use Only <br /> certified true and correct. Date Issued Clerk <br /> By <br /> CUSTOMER COPY <br /> Hawai'i County is an Equal Opportunity Provider and Employer <br />