EXEMPT LICENSE PLATE REQUEST
A Public Service Agency
Complete Section A, B, and sign Section C.
A. VEHICLE INFORMATION
LICENSE PLATE NUMBER VEHICLE IDENTIFICATION NUMBER
YEAR/MAKE
3FTTW8A34RRA33213 2024 FORD MAVERICK
B. EXEMPT LICENSE PLATES CERTIFICATION Check only one box to qualify for California exempt license plates. (California Vehicle Code [CVC] Sections 4155, 9101, 9102, 9103, 9104, 9106).
Your agency is qualified for this exemption if your agency is the registered owner, legal owner, or lessee. Qualification is based on:
U.S. Government
PRINT NAME OF AGENCY
State Agency _
PRINT NAME OF AGENCY
County Agency
PRINT NAME OF AGENCY
City Agency CITY OF REDONDO BEACH
PRINT NAME OF AGENCY
American Red Cross
Political Subdivision
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(Any city, city and county, municipality, county tax or assessment district or other legally authorized local government entity with jurisdictional boundaries. Does not apply to sovereign nations.) Joint Powers Agreement
PRINT NAME OF AGENCIES
(Two or more public agencies authorized by their legislative or other governing bodies, may jointly exercise any power common to the contracting parties, even though one or more of the contracting agencies may be located outside this Public Fire Department
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(Organized as a nonprofit corporation and used exclusively for fire fighting or rescue or exclusively as an ambulance.) Voluntary Fire Department
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(Registered with the County Clerk and located in an unincorporated area and used exclusively for fire fighting or rescue or exclusively for fire fighting or exclusively for ambulance.) Civil Air Patrol
PRINT NAME OF AGENCY
(Vehicle transferred by the U.S. Government, or any agency thereof, to the Civil Air Patrol may be issued exempt registration provided the use of the vehicle is restricted to defined activities of the Civil Air Patrol and the vehicle must be returned to the U.S. Government when no longer required or suited for use by the Civil Air Patrol.) Federally-Recognized Indian Tribes
PRINT INDIAN TRIBAL NAME
(Utilized under a mutual aid agreement with a state, county, city or other governmental municipality and used exclusively for fire protection and emergency response.)
C. APPLICANT'S SIGNATURE
/ certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct. I further certify that the owner of this vehicle qualifies for exempt registration under one of the following sections of the CV: 4155, 9101, 9102, 9103, 9104, 9106.
SIGNATURE
DATE
X
EXECUTED AT CITY
STATE
PRINTED NAME OF PERSON SIGNING FOR AGENCY
] DAYTIME TELEPHONE NUMBER
)
AGENCY ADDRESS STREET CITY
STATE ZIP CODE
REG 5050 (REV. 12/2008) wwW