HomeMy WebLinkAboutApplication for Bicycle and Moped Registration Permanent Registration Fee$15.00 DEPARTMENT OF FINANCE Validation No.
VEHICLE REGISTRATION&
Replacement Decal Fee$2.00(Tag No. LICENSING DIVISION H
_Duplicate Registration Fee$5.00 101 PAUAHI STREET,SUITE#5
HAWAII 96720
_Transfer Fee$5.00 HILO, PERMANENT
APPLICATION FOR BICYCLE AND MOPED REGISTRATION (NO EXPIRATION)
PRINT CLEARLY IN INK OR TYPE
OWNER PHONE NO.
MAILING ADDRESS
CITY/STATE ZIP CODE
MAKE YEAR MODEL COLOR SERIAL NO.
MEN'S E_] WOMEN'S F__1 SPEED WHEEL SIZE MOPED F__] H.P.
FROM WHOM ACQUIRED DATE ACQUIRED NEW F__j USED
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.
Date Signature of Owner
If new bicycle or moped purchased locally,dealer must sign below. This application is VRL Use Only
certified true and correct. Date Issued Clerk
By
VRL OFFICE COPY
Hawai'i County is an Equal Opportunity Provider and Employer
_Permanent Registration Fee$15.00 DEPARTMENT OF FINANCE Validation No.
VEHICLE REGISTRATION&
Replacement Decal Fee$2.00(Tag No. LICENSING DIVISION H
-Duplicate Registration Fee$5.00 101 PAUAHI STREET,SUITE#5
Transfer Fee$5.00 HILO,HAWAII 96720
— PERMANENT
APPLICATION FOR BICYCLE AND MOPED REGISTRATION (NO EXPIRATION)
PRINT CLEARLY IN INK OR TYPE
OWNER PHONE NO.
MAILING ADDRESS
CITY/STATE ZIP CODE
MAKE YEAR MODEL COLOR SERIAL NO.
MEN'S E-1 WOMEN'S F__j SPEED WHEEL SIZE MOPED F H.P.
FROM WHOM ACQUIRED DATE ACQUIRED NEW F__] USED
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.
Date Signature of Owner
If new bicycle or moped purchased locally,dealer must sign below. This application is VRL Use Only
certified true and correct. Date Issued Clerk
By
CUSTOMER COPY
Hawai'i County is an Equal Opportunity Provider and Employer