Motor Vehicle Registration Form

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MOTOR VEHICLE REGISTRATION FORM
Please bring your vehicle registration
$10.00 -First vehicle parking decal
$2.00 - For each additional vehicle
A.
Driver Information:
Student/Employee ID
Name
Campus Address
Home Address
Campus Phone
City,ST
ZIP
Status:
University Employee
Commuting Student
Home Phone
Resident Student
Fitness Center Member
B.
Owner Information (if different from driver):
Name
Home Phone
Home Address
C.
Auto/Bicycle Information:
(Circle One) Passenger Car (Regular) - Conservation (Loon) - UMaine System - UMaine
Athletics (Black Bear) - Handicap - Veteran - Disable Veteran - Commercial -
Combination - Motorcycle - Firefighter – Lobster - Other
Make
Model
Year
Color
License Plate #
State
D.
Agreement and Acknowledgement:
I, the undersigned, understand that this motor vehicle or any other motor
vehicle with a state registration in my name, is subject to be towed at my expense
when found in violation of the University of Maine at Presque Isle parking and
traffic policies and procedures.
I authorize the transfer of unpaid tickets to my
student account.
I acknowledge that I have received a copy of the University of
Maine at Presque Isle parking and traffic policies and procedures and its official
parking map.
The decal issued to me is for personal use of this motor vehicle.
I
further understand that if my decal is not properly displayed or if I fail to obtain
a temporary permit should my decal be misplaced, then I will be obligated to pay any
towing or ticket fines levied on my vehicle.
I acknowledge that the University is
not responsible for any damage that might occur to my vehicle as a result of parking
on campus.
1.
Monetary fine
2.
Towing
Signature ________________________________Date ___________________________________
E.
********************For Office Use Only:*******************************************
Name of issuing person
1.
Permit issued _______________________
2.
Date issued ___________________
3.
Payment received $ __________________
4.
Circle:
1st
2nd
3rd
4th
08-16-08

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