Form R 190 PDF Details

In the State of Connecticut, the Department of Motor Vehicles issues the R-190 form, also known as the Green Light Permit Certification. This crucial document is designed for active members of volunteer ambulance departments, enabling them to use flashing lights and sirens on their personal vehicles. The R-190 form requires detailed information including the operator’s license number, vehicle year, make, registration plate number, and vehicle identification number, ensuring that all pertinent details are registered with the Flashing Lights and Siren Unit. Applicants must type or print the information clearly and submit the completed forms to the designated address by a specific deadline, usually by the end of January each year. Moreover, the form includes a section for certification by the chief executive officer of the volunteer ambulance department or company, attesting to the accuracy of the information provided and confirming compliance with Section 14-96p of the Connecticut General Statutes (C.G.S.). This process ensures that only authorized individuals are granted the privilege to operate vehicles with such alarming and signaling devices, highlighting the state’s commitment to effective emergency response and public safety management. It stands as a testament to the structured approach taken to assist volunteer emergency responders in performing their duties more efficiently, thereby contributing to the overall well-being and safety of the community.

QuestionAnswer
Form NameForm R 190
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesR 190 ct state green light permit form

Form Preview Example

GREEN LIGHT PERMIT CERTIFICATION

R-190 REV. 9-2001

STATE OF CONNECTICUT

DEPARTMENT OF MOTOR VEHICLES

 

 

FLASHING LIGHTS AND SIRENS UNIT

 

60 STATE STREET, WETHERSFIELD, CT 06161

 

TELEPHONE NUMBER: (860) 263-5410

 

On The Web At http://dmvct.org

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 AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE DEPARTMENT MEMBER

 

OPERATOR'S LICENSE NUMBER

 

 

 

 

 

YEAR

MAKE

REGISTRATION PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

 

 

 

 

 

NAME AND ADDRESS OF ACTIVE VOLUNTEER AMBULANCE 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 ambulance department or company or an active member of an organized civil preparedness auxiliary ambulance 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 AMBULANCE DEPARTMENT OR COMPANY

ADDRESS OF VOLUNTEER AMBULANCE DEPARTMENT MEMBER

AUTHORIZED SIGNATURE

X

TITLE

DATE SIGNED

How to Edit Form R 190 Online for Free

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1. To start with, while filling in the Form R 190, beging with the area containing subsequent blanks:

Form R 190 completion process described (step 1)

2. Now that the previous segment is done, you should add the necessary particulars 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 on to the 3rd stage.

REGISTRATION PLATE NUMBER, VEHICLE IDENTIFICATION NUMBER, and MAKE inside Form R 190

It's simple to make an error while filling in the REGISTRATION PLATE NUMBER, consequently be sure to take another look prior to deciding to finalize the form.

3. This step is generally simple - complete all of the fields in NAME OF VOLUNTEER AMBULANCE, ADDRESS OF VOLUNTEER AMBULANCE, AUTHORIZED SIGNATURE X, TITLE, and DATE SIGNED to conclude this segment.

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