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Sos Pov Decal App (2)

Sos Pov Decal App (2)

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Published by Fort Hamilton Sos

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Published by: Fort Hamilton Sos on Apr 22, 2011
Copyright:Attribution Non-commercial

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11/27/2013

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ARMYSURVIVOROUTREACHSERVICES(SOS)VEHICLEDECAL
Installation:SurvivorOutreachServices/ACSOfficeAttention:Address:Phone:Fax:E-mail:
SECTIONI
REQUIREMENTSFORDECALRECEIPENTS:
1.
QualifiedSurvivor
2.
Mustbepresentedinperson
3.
MustcompleteallrequireddocumentsNameofSurvivor:
tWA
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MailingAddress:
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City:
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State:
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Code:)
13bLf
TelephoneNumber(s)Main:
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E-mail:
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SocialSecurity:
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DriverLicense:
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State:
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SoldierName:
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Rank:
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D
DisapprovedReason:Date:DirectorofEmergencyServices/ProvostMarshal'sOfficeSignature:
SECTIONII
PLEASEBRINGWITHYOU:
D
Currentproofofvehicleinsurance
D
StatephotoidentificationcardorPassport
D
Currentvehicleregistration
D
Militaryidentificationcard
D
Vehiclesafetyinspection(presentonvehicle)
D
SurvivorVehicleDecalInstallationVehicleRegistrationhoursofoperation:Address:TelephoneNumber:PointOfContact:SurvivorSignature:
k
h/L.
Date:
1tkt(,~
oil;
7-01/
SurvivorOutreachServices/ACSStaffSignature:Date:
:.,..:....',,.:.<..,.;.;'....:.:........:'.,.'......:....•....:..:......:........
n:...···
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AddedtoClieDtTrickiDilSvst~m:..
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"Verified.hi'DefenseCasualtyJitformationprocessinsr.Svstem:.
PrivacyActStatement
Authority;5U.S.C.
301
DepartmentRegulations;10U.S.C.
3013,
SecretaryoftheArmy,ArmyRegulation190-13,TheArmyPhysicalSecurityProgramandExecutiveorder9397(SSN)Purpose;Toensurepositiveidentificationofnon-DoDindividualsseekingaccesstoU.S.ArmyInstallations.RoutineUses;None.The"BlanketRoutineUses"setfortatthebeginningoftheArmy'scompilationofSystemRecordsNoticesapplytothissystem.Disclosure:Voluntary;however,failuretoprovidetherequestedinformationmayresultindenialofaccesstoU.S.ArmyInstallations.
 
ARMYSURVIVOROUTREACHSERVICES(SOS)VEHICLECeCAL
Installation:SurvivorOutreachServices/ACSOfficeAttention:Address:Phone:Fax:E-mail:
SECTIONI
1.
QualifiedSurvivorREQUIREMENTSFORDECALRECEIPENTS:
2.
Mustbepresentedinperson
3.
MustcompleteallrequireddocumentsMailingAddress:~
,P
q
43
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1(
1$
0
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City:
AI
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£
State:
f
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ZipCode:
/11r
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TelephoneNumber(s)Main:
'117
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E-mail:,_SocialSecurity:
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2.
35t2.2....1St"ate:._.....__+--_
[]iAPprOVed
D
DisapprovedReason:Date:~..;.____-,--DirectorofEmergencyServices/ProvostMarshal'sOfficeSignature:
SECTIONII
PLEASEBRINGWITHYOU:[E'Currentproofofvehicleinsurance
[fJ
Currentvehicleregistration[~}jehiclesafetyinspection(presentonvehicle)InstallationVehicleRegistrationhoursofoperation:,__-----:--:----:-_Address:
Itt
~-3
2
731t
tI~jtAr/12
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7
TelephoneNumber:
qI7f)215h
7
r9
PointOfContact:[]StatephotoidentificationcardorPassport
D
Militaryidentificationcard
D
SurvivorVehicleDecalSurvivorSignature:
c_~
,11415:
Date:
3j'L
91/t
SurvivorOutreachServicesJACSStaffSignature:,Oate:,_
;";;virlti~ai~:D~i~j.~~'c~'~~.i~'iliforIliiti~~:Pt~~~iri~·s~~t~~'~··
'>:.'.
:':Add~··t6.di~~t·::r~~"di~~S~~t~~~',:","',';'
PrivacyActStatement
Authority:5U.S.C.301DepartmentRegulations;10U.S.C.3013,SecretaryoftheArmy,ArmyRegulation190-13,TheArmyPhysicalSecurityProgramandExecutiveorder9397(SSN)Purpose:Toensurepositiveidentificationofnon-DoDindividualsseekingaccesstoU,S.ArmyInstallations.RoutineUses:None.The"BlanketRoutineUses"setfortatthebeginningoftheArmy'scompilationofSystemRecordsNoticesapplytothissystem.Disclosure:Voluntary;however.failuretoprovidetherequestedinformationmayresultindenialofaccesstoU.S.ArmyInstallations.
 
NYSDEPARTMENTOFMOTORVEHICLES
INSPECTIONRECEIPT
TestDate:
3/11/20
IIPrintDate:
3/11/20
IIInspectionType:Initial
I
I..
PageIofIVIN:tLNHM87A94V642837YEAR:2004MAKE:
LINCOLN
MODEL:
LS
PLATE:FDM1409MILEAGE:70907FUELTYPE:GasolineVEHICLEWT.O-8500Ibs.EIR#:181780
INSPECTIONRESULT:PASS
InspectionFee
$37.00
SAFETY:EMISSIONS:
PASSPASS
STICKERNUMBER:03043500EXPIRATION:
3/3112012
ATTENTIONMOTORIST:
Congratulations,yourvehiclehaspasseditsannualNewYorkStateinspection.Pleaseretainthisreceiptforyourrecords,Youmayberequiredtopresentthisreceiptinordertorenewyourvehicleregistration.
The
resultsoftheinspectionwillbetransmittedelectronicallyto
DMV,
usuallywithin24hours.Wheel(s)removedtoinspectbrakes:LlF,LlR,RlF,RlRPhone:StationNo.InspectorNo.HEMPSTEADAUTOCAREINC219-06HEMPSTEADAVQUEENSVILLAGE,NY11429(718)479-5125InspectionPerformedOnline:YESNYVIPRecordNumber9323DMVRECORDMATCH:BStationNameAddress70821562T93
IIIIII~IIIIIIII
VEHICLEINSPECTIONQUESTIONSForadditionalinformationpleasecontacttheDepartmentofMotorVehiclesat:
I,
WebsiteAddress:
www.NYSDMV.com(vehsafe.htm.TelephoneNumber:(212)645-5550or(718)966-6155NYVIPUnitNo.A000005273Name
I
RO#:

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