Form Blc-56 - Application For Red Light And/or Siren Permit Page 2
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1
2Motor Vehicle
Business Licensing Services Bureau
P.O. Box 168
Commission
Trenton, New Jersey 08666-0168
Phone:(609) 292-6500 ext.5095
APPLICATION FOR RED LIGHT AND/OR SIREN PERMIT
Dat e
I,_____________________________________________________________________________________________
(print name and address of applicant)
*
hereby apply for a Red Light/Siren Permit for the following vehicle:
N.J. Driver License Number
Name of Registered Owner/Lessee
Street Address
City, County, State and Zip
Describe use of ve hicle
Signature of Applicant____________________________________________ Title_________________________
Organization_________________________________________________ Corp Code______________________
Please check one in each section:
Paid Employee
Vehicle provided by Department
Volunteer
This section is to be completed by the MAYOR OR CHIEF EXECUTIVE OFFICER of the governing body of the municipality
being served by the police department, fire company, first aid squad or emergency equipment manufacturer.
I,_______________________________________, have read the information on the reverse side of this application
please print
pertaining to red light/siren permit for the vehicle described above and believe the applicant qualifies for a permit.
*Current Blue Light permit must be
Signature
surrendered with this application.
Title
ATTACH THE FOLLOWING:
Governing Body
A copy of the registration for the
vehicle described above; if the vehicle
Address
is leased, a copy of the lease
agreement.
City, County, Zip
Information pertaining to red light/siren permits is on the back of this application.
BLC-56 (R12/08)
MVC Web Site
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