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Form App46 - Application For Volunteer Firefighter Plates/ground Search And Rescue Plates - Nova Scotia

Application for Volunteer Firefighter Plates/

Service Nova Scotia

P.O. Box 1652, Halifax, NS B3J 2Z3

Ground Search and Rescue Plates

PLEASE PRINT ALL INFORMATION IN BLOCK LETTERS

Phone 902 424-5851 • Toll Free 1 800 898-7668

SECTION 1 — Applicant Identification

Name of Applicant

Applicant Master Number

Residence Address

Mailing Address

Postal Code

SECTION 2 — Vehicle Information

VIN / Serial Number

Year _____________ Make _________________ Model ___________ Body Type _______________________ Registered Weight ________________

SECTION 3 — Plate Information

Current / Previous Plate

Prov / State

Attach Plate Number

NO FEE REQUIRED

Initial

Renewal

NOTE: Applicant must be the registered owner of the vehicle or have written authorization from the vehicle owner.

I HEREBY ACKNOWLEDGE that by displaying Volunteer Firefighter Plates or Ground Search and Rescue Plates I am not granted any authority to exceed

posted speed limits or claim extra right-of-way and I also absolve the Province of Nova Scotia from any civil liability resulting from any accident.

I HEREBY ACKNOWLEDGE that if I cease to be an active member of a Volunteer Fire Department or Ground Search and Rescue Organization my volunteer

vehicle registration will no longer be valid.

Signature of Applicant _________________________________________________________________ Date __________________________________

SECTION 4 — To Be Completed by Chief or Deputy Chief / GSAR Team President

Volunteer Fire Department / Ground Search and Rescue Organization

Address

Telephone Number

I HEREBY CERTIFY that the above noted applicant is an active volunteer member in the above Fire Department or Ground Search and Rescue Organization.

Signature of Chief or Deputy Chief or Team President ______________________________________________________ Date ______________________

NOTE: For purposes of this application an “active volunteer member” means a person who: has been a member of a Volunteer Fire Department or Ground

Search and Rescue Organization for the past 12 months and intends to remain so and has participated in a minimum of 20% of calls and training.

Form APP46 (Rev. 02/03)

2004D

Form App46 - Application For Volunteer Firefighter Plates/ground Search And Rescue Plates - Nova Scotia