Fillable Printable Rtb 2007 051 Attach2
Fillable Printable Rtb 2007 051 Attach2
Rtb 2007 051 Attach2
~
~
Texe.
Department
of
Transportation
FormVTR-76
(Rev.11/2007)
(GSD-EPC)
Page1of1
Applicationfor
DisasterReliefVehicle
LicensePlates
ForCountyUseOnly
LicenseNumber_
MolYrofExp_
DateIssued_
Submitthecompletedapplication,paymentintheformofapersonalcheck,moneyorderorcashier'scheck,andanyrequiredattachmentstoyour
localCountyTaxAssessor-Collector'soffice.Donotmailcash.Thelicenseplatefeeis$5.30peryear.
NOTE:TheregistrationyearforthistypeoflicenseplateexpiresonMarch31stofeachyear.
Ifyouplaceyourorder·bymail,pleasecontactyourCountyTaxAssessor-Collector'sofficeintwoweekstoverifyyourplateisreadyforissuance.
Specialtyplatefeeswillnotberefundedonceapplicationissubmitted.ContactyourCountyTaxAssessor-Collectorifyouhaveanyquestions.
LastName(iftitledinindividual'sname)IFirstName
MiddleInitial
County
Address
DayPhone
CurrentTXPlateIYear
VehicleIdentificationNumber
AlternatePhone
Make
E-mail
BodyStyle
YearofExpiration
State
ZipCode
Emergencyequipmentinvehicle:
Mysignatureindicatestheinformationaboveistrueandcorrect,andthevehicledescribedisthepropertyoftheabovenamed
ownerororganizationandisusedexclusivelybysameandsolelyforemergenciesindisasterreliefwork.
Ifthevehicledescribedisusedforanypurposeotherthanemergencyusage,statelawrequiresthatthelicenseplateand
registrationinsigniabereturnedtoyourCountyTaxAssessor-Collectorforcancellation,andsuchvehiclewillnotbeexempted
fromtheregularregistrationfeesatanyfuturetime.
NameofDisasterReliefOrganizationOfficer
Officer'sSignature
VehicleOwnerSignature(ifapplicable)
Date
Date
•Forvehiclesusedindisasterreliefthatareoperatedbyanon-profitdisasterrelieforganization.
•Name
of
thenon-profitorganizationmustbedisplayedoneachfrontsidedooronmotorvehicles.
•Availableforcommercialmotorvehiclesincludingtrailersandsemitrailers.
fORMVTR-76Page'Iof'I
