HomeMy WebLinkAboutFillable App for Bicycle Registration[ ]
[ ]Electric $30.00[ ]Transfer Fee $5.00
[ ]
[ ]Replacement Decal Fee $2.00 Tag No.
CITY/STATE
MAKE
SPEED
Date
By
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
101 PAUAHI STREET, SUITE #5
APPLICATION FOR BICYCLE / LOW-SPEED ELECTRIC REGISTRATION
[ ]Permanent Registration Fee $15.00
[ ]LowSpeed Electric $30.00 [ ]Transfer Fee $5.00
[ ]Duplicate Registration Fee $5.00
[ ]Replacement Decal Fee $2.00 Tag No.
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 age or older,hereby certifies that the serial number furnished above is the actual number takenfrom 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 age or older,hereby certifies that the serial number furnished above is the actual 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 purchased locally,dealer must sign below.This application is certified
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 purchased locally,dealer must sign below.This application is certifiedtrue 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