PTD 21

APPLICATION FOR PARTICIPATION IN W. W. 31-18-207 AND AUTHORIZATION FOR COLLECTION OF FEES IN LIEU OF REGISTRATION ON MOBILE MACHINERY THAT IS RENTED OR LEASED OWNER____________________________________________

TREASURERS USE ONLY

BUSINESS NAME___________________________________

Reporting Year_________________

MAILING ADDRESS________________________________

County Name___________________

CITY______________________________________________

Treasurers Authorization_________

BUSINESS ADDRESS_______________________________

Date___________________________

DESCRIPTION

YEAR

MAKE & MODEL

VIN #

SERIAL #

DECAL #

I certify that the above Mobile Machinery is held as inventory by the owner, and will be leased or rented for periods of at least 60 days in duration. Signature_______________________________________

Title_____________________________ Date__________

Signature of owner or authorized agent COPY:

COUNTY WHERE MOBILE MACHINERY WAS USED WITH REMITTANCE DUE FOR THAT COUNTY COUNTY THAT ISSUED THE DECALS

application for participation in ww 31-18-207 and authorization for ...

APPLICATION FOR PARTICIPATION IN W. W. 31-18-207. AND AUTHORIZATION FOR COLLECTION OF FEES IN LIEU OF REGISTRATION. ON MOBILE ...

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