Golf Cart Inspection Form
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1GRANT COUNTY SHERIFF’S OFFICE
PO Box: 37
Ephrata, WA 98823
GOLF CART INSPECTION FORM
CONTROL #:
(Office use only)
MAKE CHECKS PAYABLE TO GRANT COUNTY
$50 FOR NEW REGISTRATION
$35 FOR RENEWAL
GOLF CART MAKE:
MODEL:
YEAR:
TYPE OF PROPULSION:
COLOR:
GAS
ELECTRIC
SERIAL
#/VIN:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
DOCUMENTATION
DOCUMENT(S) PRESENTED
SERIAL #/VIN AGREES
TO SUPPORT OWNERSHIP:
YES
NO
WITH DOCUMENTS:
PREVIOUS REG# _________
BILL OF SALE
TITLE
(office use only)
INSPECTED EQUIPMENT
REFLECTORS
SEAT BELTS
2 MIRRORS (LEFT SIDE AND CENTER OR RIGHT SIDE)
DEFECTS OR MODIFICATIONS PREVENTING REGISTRATION
APPLICANT INFORMATION
OWNER:
HOME PHONE:
CELL PHONE:
MAILING ADDRESS:
CITY
STATE
ZIP
DRIVERS LICENSE #:
STATE:
VERIFICATION
THIS INSPECTION IS CONCERNED WITH THE IDENTITY AND LICENSABILITY AND IN NO WAY GUARANTEES THE
GOLF CART TO BE FREE FROM DEFECTS. ALL STATEMENTS MADE BY ME ARE TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE AND ARE ACCURATELY REPRESENTED HERE. I HAVE READ AND UNDERSTAND THE
ABOVE.
SIGNATURE OF APPLICANT:
DATE: ______________________
INSPECTING DEPUTY:
BADGE # _______________________
(deputy signature not required on renewals)
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