Transcription of LOUISIANA DEPARTMENT OF PUBLIC SAFETY - …
1 LOUISIANA DEPARTMENT OF PUBLIC SAFETY - OFFICE OF STATE POLICE motor VEHICLE INSPECTION WEEKLY REPORTFor Week EndingFRI20 For Month Ending20 LAST STICKER PREVIOUS PAGELAST STICKER NO FROM PREVIOUS PAGEREJECTION STICKER NUMBERNEW STICKER NUMBER1234567891011121314151617181920 Signed for Station ByDateNo. FailedNo. ApprovedNo. IssuedDPSSP 1023 (R 11/15)Station NameAddress (Street/City/State/Zip Code)CLASSIFICATION OF VEHICLE CODESA - Automobile SS - School Bus TT - Tractor Trailer ST - Semi-Trailer B - Bus PU - Pickup Truck UT - UtilityTrailer M - Motorcycle SUV -Sport Utility VehicleAll vehicles inspected must be shown. Report MUST be legible and written in BLACK INK CODES1 - Tires, Wheels, Rims 2 - Exhaust and Fuel System 3 - Brakes Serv (Foot and Park) 4 - Light and Electrical System5 - Other SAFETY Equipment and Body Items 6 - Vehicle Glazing -Windshield and all Glasses and Drivers Window Lift MechanismPRINT MECHANICS NAMEDATEIDENTIFICATION NUMBER MUST CORRESPOND WITH REGISTRATIONPREVIOUS MVI STICKER NUMBERVEHICLE MILEAGE RECORDED FROM ODOMETERV ehicle License PlateI HAVE AND WILL MAINTAIN LIABILITY SECURITY REQUIRED BY STATE LAW, FALSE DECLARATION WILL RESULT IN A 6 MONTH SUSPENSION OF DRIVING PRIVILEGES.
2 (Signature of Applicant Below)VALID OPERATORS DRIVERS LICENSE (SHOW STATE IF OTHER THAN LA)YEAR MODELMAKECLASSIFICATION CODE OF VEHICLE TYPEREJECTION CODETOTALS
