Blue Light Permit Certification Form – Fill Out and Use This PDF

The Blue Light Permit Certification Form (R-114 Rev. 9-2001) is a critical document issued by the State of Connecticut Department of Motor Vehicles, specifically tailored for active members of volunteer fire departments or organized civil preparedness auxiliary fire companies. It serves to authorize the use of flashing lights and sirens on personal vehicles, facilitating their crucial role in emergency response. To ensure compliance and receive the necessary certification, active members must submit the completed form to the designated unit within the specified timeframe.

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Blue Light Permit Certification Form PDF Details

As a cornerstone of emergency response within the community, the Blue Light Permit Certification form, identified as R-114 and last revised in September 2001, stands as a significant document within the State of Connecticut, managed by the Department of Motor Vehicles' Flashing Lights and Sirens Unit. With its detailed instructions, this form demands clear typing or printing and anticipates additional forms for completion if necessary. The stringent requirement to have these forms returned by the last day of January each year underscores its importance. The form meticulously collects information ranging from the name and address of active volunteer fire department members to their operator’s license number, and details about their vehicle such as year, make, registration plate number, and vehicle identification number. Furthermore, an essential component of this form is the certification by the chief executive officer, who must affirm the accuracy of the submitted information and confirm the issuance of light permits in accordance with Section 14-96p C.G.S. This certification not only validates the document but also serves as a legal attestation of the volunteer members' active role and their right to operate vehicles equipped with flashing lights and sirens, enhancing their capacity to serve and protect the community effectively.

Question	Answer
Form Name	Blue Light Permit Certification Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	gov, dmv, ct blue light laws, ct blue light permit

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BLUE LIGHT PERMIT CERTIFICATION

	R-114 REV. 9-2001	STATE OF CONNECTICUT
	R-114 REV. 9-2001	DEPARTMENT OF MOTOR VEHICLES
		DEPARTMENT OF MOTOR VEHICLES
		FLASHING LIGHTS AND SIRENS UNIT
		60 STATE STREET, WETHERSFIELD, CT 06161
		TELEPHONE NUMBER: (860) 263-5410
		On The Web At ct.gov/dmv

INSTRUCTIONS:

1.Type or Print Clearly. Use additional forms as necessary.

2.Return the completed form(s) to the Flashing Lights and Siren Unit at the address above no later than the last day of the month of JANUARY.

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

NAME AND ADDRESS OF ACTIVE VOLUNTEER FIRE DEPARTMENT MEMBER				OPERATOR'S LICENSE NUMBER

YEAR	MAKE	REGISTRATION PLATE NUMBER	VEHICLE IDENTIFICATION NUMBER

CERTIFICATION BY CHIEF EXECUTIVE OFFICER

In compliance with Section 14-96p C.G.S., light permits have been issued to the above specified active members of a volunteer fire department or company or an active member of an organized civil preparedness auxiliary fire company of which I am the chief executive officer. I hereby certify that the above information is true and accurate to the best of my knowledge and belief.

NAME OF VOLUNTEER FIRE DEPARTMENT OR COMPANY

ADDRESS OF VOLUNTEER FIRE DEPARTMENT OR COMPANY

AUTHORIZED SIGNATURE

TITLE

DATE SIGNED

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Completing this form demands attention to detail. Make certain all mandatory blanks are completed accurately.

1. The ct blue light laws will require certain details to be typed in. Ensure the next blank fields are filled out:

ct blue light permit conclusion process described (stage 1)

2. Once the previous part is complete, you're ready to put in the essential details in YEAR, MAKE, REGISTRATION PLATE NUMBER, VEHICLE IDENTIFICATION NUMBER, NAME AND ADDRESS OF ACTIVE, OPERATORS LICENSE NUMBER, YEAR, MAKE, REGISTRATION PLATE NUMBER, VEHICLE IDENTIFICATION NUMBER, NAME AND ADDRESS OF ACTIVE, OPERATORS LICENSE NUMBER, YEAR, MAKE, and REGISTRATION PLATE NUMBER in order to move forward to the next stage.

YEAR, YEAR, and VEHICLE IDENTIFICATION NUMBER of ct blue light permit

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Blue Light Permit Certification Form – Fill Out and Use This PDF

Blue Light Permit Certification Form PDF Details

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