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 _______________________________________________________________________________ State Agency __________________________________________________________________________________ County Agency ________________________________________________________________________________ City Agency ___________________________________________________________________________________ American Red Cross
Political Subdivision ___________________________________________________________________________ (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 ________________________________________________________________________ (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 state. Must be registered with the Secretary of State.) Public Fire Department _________________________________________________________________________ (Organized as a nonprofit corporation and used exclusively for fire fighting or rescue or exclusively as an ambulance.) Voluntary Fire Department ______________________________________________________________________ (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 _________________________________________________________________________________ (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 _______________________________________________________________ (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
I 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 CVC: 4155, 9101, 9102, 9103, 9104, 9106.
SIGNATURE DATE
EXECUTED AT CITY STATE
PRINTED NAME OF PERSON SIGNING FOR AGENCY DAYTIME TELEPHONE NUMBER
AGENCY ADDRESS STREET CITY STATE ZIP CODE
A. VEHICLE INFORMATION
X
( )
A Public Service Agency
EXEMPT LICENSE PLATE REQUEST
Complete Section A, B, and sign Section C.
LICENSE PLATE NUMBER VEHICLE IDENTIFICATION NUMBER YEAR/MAKE REG 5050 (REV. 12/2008) WWW
PRINT NAME OF AGENCY
PRINT NAME OF AGENCY
PRINT NAME OF AGENCY
PRINT NAME OF AGENCY
PRINT NAME OF AGENCIES
PRINT NAME OF AGENCY
PRINT NAME OF AGENCY
PRINT NAME OF AGENCY
PRINT INDIAN TRIBAL NAME
PRINT NAME OF AGENCY
1FM5K8GC0RGA18769 2024/FORD ✔ CITY OF REDONDO BEACH 5/7/2024 REDONDO BEACH CA JAMES A. LIGHT 531 N GERTRUDA AVE REDONDO BEACH CA 90277