HomeMy WebLinkAboutApplication for Bicycle Registration[ ]
[ ]Electric $30.00 [ ]Transfer Fee $5.00
[ ]
[ ]Replacement Decal Fee $2.00 (Tag No. __________)Tag No.
CITY/STATE
MAKE
SPEED
Date
By
[ ]
[ ]LowSpeed Electric $30.00[ ]Transfer Fee $5.00
[ ]
[ ]Replacement Decal Fee $2.00 Tag No.
SPEED
By
VRL Use Only
Date Issued Clerk
Validation No.
PRINT CLEARLY IN INK OR TYPE
DEPARTMENT OF FINANCE
MAKE
CITY/STATE
Clerk
H -
Hilo, Hawaii 96720
PERMANENT
OWNER
ZIP CODE
Duplicate Registration Fee $5.00 101 PAUAHI STREET, SUITE #5
APPLICATION FOR BICYCLE / LOW-SPEED ELECTRIC REGISTRATION
Permanent Registration Fee $15.00
PHONE NO.
Validation No.
H -
PERMANENT
VEHICLE REGISTRATION &
LICENSING DIVISION
(NO EXPIRATION)
Permanent Registration Fee $15.00
Duplicate Registration Fee $5.00
PRINT CLEARLY IN INK OR TYPE
DEPARTMENT OF FINANCE
101 PAUAHI STREET, SUITE #5
FROM WHOM ACQUIRED DATE ACQUIRED
MAILING ADDRESS
ELECTRIC HPP/SPD
The undersigned,being 18 years of ageor older,hereby certifies that theserial number furnished above is theactual number taken
from the bicycle or moped and that the foregoing statements are true to the best of my knowledge and belief.
Signature of Owner
APPLICATION FOR BICYCLE / LOW-SPEED ELECTRIC REGISTRATION (NO EXPIRATION)
MEN'S ( )
The undersigned,being 18 years of ageor older,hereby certifies that theserial number furnished above is theactual number taken
from the bicycle or moped and that the foregoing statements are true to the best of my knowledge and belief.
Signature of OwnerDate
NEW ( )
WOMEN'S ( )
Hawai'i County is an Equal Opportunity Provider and Employer
Hawai'i County is an Equal Opportunity Provider and Employer
VRL OFFICE COPY
CUSTOMER COPY
If new bicycle purchasedlocally,dealer must sign below.Thisapplicationiscertified
true and correct.
VRL Use Only
Date Issued
FROM WHOM ACQUIRED
Hilo, Hawaii 96720
MEN'S ( )WOMEN'S ( )
YEAR
OWNER
VEHICLE REGISTRATION &
LICENSING DIVISION
If new bicycle purchasedlocally,dealer must sign below.Thisapplicationiscertified
true and correct.
ELECTRIC HP/SPD
NEW ( )USED ( )
YEAR
ZIP CODE
PHONE NO.
MAILING ADDRESS
USED ( )
COLOR SERIAL NO.
COLOR SERIAL NO.
DATE ACQUIRED
Created 03/17/09 Updated 12/19/2022