ARCANUM POLICE DEPARTMENT
GOLF-CART INSPECTION - DPS1373
Date
*
/
Month
/
Day
Year
Date
VEHICLE TYPE
*
UNDER SPEED VEHICLE
UTILITY VEHICLE
MINI-TRUCK
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
VEHICLE VIN
*
GROSS WEIGHT
*
MAKE
*
MODEL
*
UNLADEN WEIGHT (MINI-TRUCK)
THE ABOVE VEHICLE INCLUES THE FOLLWING EQUIPMENT AS REQUIRED
*
BREAKS
BREAKES LIGHTS (2 LIGHTS)
HEAD LIGHTS (2 LIGTHS)
TAIL LIGHTS (2 LIGHTS)
WARNING DEVICES / REFLECTORS (e.g. turn signals)
STERRING MECHANISM
WINDSHIELD
REARVIEW MIRROR
TIRES (INSAFE OPERATING CONDITIONS)
ONLY....UTILITY VEHICLE / MINI-TRUCK TIRES MUST BE "DOT" APPROVED
YES
NO
COMMENTS
OFFICER'S NAME
*
First Name
Last Name
OFFICER'S BADGE #
*
Officer's Email
example@example.com
OFFICER Signature
*
OWNER'S Email
*
example@example.com
File Upload (Upload picture of VIN)
*
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