Form Dpssp 1061 PDF Details

Form Dpssp 1061 is a key form that all businesses should be familiar with. This form is used to report certain transactions to the IRS, and it's important to understand when and how to use it. In this blog post, we'll go over the basics of Form Dpssp 1061 so you can make sure you're following all the necessary reporting requirements. We'll also discuss some common scenarios in which this form would be required. Stay tuned!

QuestionAnswer
Form NameForm Dpssp 1061
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesWindowTintExemp tion Security authorization form for medical window tint exemption louisiana

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STATE OF LOUISIANA

PARISH OF ______________________________

NOTE: LRS 32:361.1 provides that the legal limits for a sun screening device (window tint) on passenger car are light transmissions of 40% for the front side windows, 25% for the rear side windows and 12% for the rear windshield.

BEFORE ME, the undersigned Notary, personally came and appeared:

NAME & DRIVER’S LICENSE NUMBER

ADDRESS

CITY, STATE, ZIP, (AREA CODE) PHONE NUMBER

Declaring that he/she is the registered owner of the following described vehicle registered in the State of Louisiana.

YEAR

MAKE

MODEL

VEHICLE IDENTIFICATION NO.

LICENSE PLATE

__________

________________

________________

____________________________________

_____________________

Affiant further declares that, pursuant to L.R.S. 32:361.3, valid security reasons (indicated below) exist which make it necessary to safely equip the above-described vehicle with sun-screening material which would be of a light transmission or luminous reflectance in violation of L.R.S. 32:361.1 and the affiant further declares that he has not been convicted of a drug offense or a violent crime and authorizes the Department of Public Safety, Office of State Police to perform a criminal history inquiry.

REASON FOR SECURITY EXEMPTION / ATTACH SUPPORTING DOCUMENTATION

I certify and attest under penalty of law, the information provided herein is true and accurate.

________________________________

____________________

SIGNATURE OF AFFIANT

DATE

SWORN TO AND SUBSCRIBED BEFORE ME THIS _________DAY OF ________________________, 20_________

_________________________________

_____________________

NOTARY PUBLIC AND SEAL

DATE

THIS SECURITY EXEMPTION IS NON-TRANSFERABLE AND EXPIRES THREE (3) YEARS FROM DATE OF ISSUANCE. THE ORIGINAL AFFIDAVIT MUST BE CARRIED IN THE VEHICLE AT ALL TIMES AND SHALL BE VOID IF THE REASON FOR THE EXEMPTION CHANGES OR NO LONGER EXISTS OR THE AFFIDAVIT IS ALTERED, FORGED OR FALSIFIED.

BELOW THIS LINE FOR STATE POLICE USE ONLY

NOT VALID UNLESS AUTHORIZED BY LOUISIANA STATE POLICE

Approved & Authorized

Disapproved

 

 

_______________________________

___________

_________

TESS-Towing & Recovery/MVI

For the Deputy Secretary, Public Safety Services

Data Number

Date

Section

DPSSP 1061 (REV 8/05)