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Louisiana Department of Public Safety and Corrections TO ...

VINMakeLicense DateBodyColorYearIf yes, what ward or district?Domicile CodeNameStreetTrade VINT rade License UsedStateLess TradeTax Value BE SURE TO SIGN AND DATEI do swearor affirm that the information containedin this documentis true andcorrect to the best of my the vehiclebeingregisteredis definedas a commercial motor vehicleby theFederal Motor Carrier Safety Regulations and/or Federal Hazardous MaterialRegulations,by signaturebelowregistrant declares knowledgeof those federalregulations.*Tax Penalty: 5% of sales tax due for 30 days or fraction thereof (not to . exceed 25%).*Interest: of sales tax due for 30 days or fraction thereof . (no maximum).PROOF OF LIABILITY INSURANCE MUST BE FURNISHED AS PROVIDED FOR BY LAW BEFORE THIS FILE CAN BE AVOID PENALTY AND INTEREST:Total FeesTotal TaxesGrand TotalTax CreditFile must be submitted within 40 days from the date of purchase.

Complete all required information P.O. Box 64886, Baton Rouge, LA 70896-4886 ELECTRONIC FUND TRANSFER CODE Driver's License or EIN Driver's License or EIN Co-Applicant's Signature Date ... 1/12/2012 4:46:56 PM ...

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