DPS1373 - Golf-Cart-Inspection

ARCANUM POLICE DEPARTMENT

GOLF-CART INSPECTION - DPS1373
Date*

MonthDayYear
Date
VEHICLE TYPE*

UNDER SPEED VEHICLEUTILITY VEHICLEMINI-TRUCK
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
VEHICLE VIN*
GROSS WEIGHT*
MAKE*
MODEL*
UNLADEN WEIGHT (MINI-TRUCK)
THE ABOVE VEHICLE INCLUES THE FOLLWING EQUIPMENT AS REQUIRED*

BREAKSBREAKES LIGHTS (2 LIGHTS)HEAD LIGHTS (2 LIGTHS)TAIL LIGHTS (2 LIGHTS)WARNING DEVICES / REFLECTORS (e.g. turn signals)STERRING MECHANISMWINDSHIELDREARVIEW MIRRORTIRES (INSAFE OPERATING CONDITIONS)
ONLY....UTILITY VEHICLE / MINI-TRUCK TIRES MUST BE "DOT" APPROVED

YESNO
COMMENTS
OFFICER'S NAME*

First NameLast Name
OFFICER'S BADGE #*
Officer's Email
example@example.com
OFFICER Signature*
OWNER'S Email*
example@example.com
File Upload (Upload picture of VIN)*

Cancelof
Should be Empty:

ARCANUM POLICE DEPARTMENT