TENNESSEE DEPARTMENT OF REVENUE
VEHICLE SERVICES DIVISION
EMERGENCY LICENSE PLATE AUTHORIZATION
FORM RV-F1313901—SIDE A
If selling an emergency vehicle use Side B
Complete this form if E-Plates, Firefighter, Rescue Squad or Trauma Physician Plates are requested
NOT REQUIRED FOR IAFF OR FOP PLATES
(This form is not necessary for renewal of emergency plates, just check name against current agency listing)
SECTION 1. GENERAL INFORMATION
Full Name of Person Requesting Emergency Plates _____________________________________________________________
Is a Member of or Retired Firefighter with the ________________________________in ____________________________, TN
(Name of Fire or Police Precinct, Rescue Squad or Emergency Management Association)
Or is a Trauma Physician, Nurse or On call Surgical staff at_______________________________________________________
Name of Hospital or Medical Center
Residential Address_______________________________________________________________________________________
City ___________________________ State ________ Zip ________________ Telephone ____________________________
Mailing Address _________________________________________________________________________________________
(If different from above)
SECTION 2. VEHICLE INFORMATION
Make ______________________ Year _____________ VIN__________________________________________________
SECTION 3. |
TYPE OF PLATE AND REQUIRED DOCUMENTATION FOR OBTAINING EMERGENCY |
|
PLATES |
|
Type of Plate—Circle Category |
E-Plate (Check one) |
Auxiliary Police Unit w/Civil Defense Authorities |
|
|
Required Documentation: Official Identification Card Tenn. Code. Ann. § 55-4-222(b) |
Civil Air Patrol/Civil Defense Organization/Emergency Management Agency
Required Documentation: Permanent Official Registration Card and a letter from the local Civil Defense/
Emergency Management Director Tenn. Code. Ann. § 55-4-222(c)
Emergency Medical Technician/Paramedic
Required Documentation: CURRENT, VALID PARAMEDIC OR EMT LICENSE Tenn. Code. Ann. § 55-4-222(d)
Full Time Police Officer
Required Documentation: Authorization from the Chief Law Enforcement Officer of the Organization Tenn.
Code. Ann. § 55-4-222(f)
Trauma Nurse
Required Documentation: Certification from Trauma Center or Emergency room confirming that applicant is a trauma nurse in their employment. Tenn. Code. Ann. §55-4-222(h)
On Call Surgical Personnel
Required Documentation: licensed or certified according to Tenn. Code Ann. Title 63 or as a surgical technologist under title 68, chapter 57, serving in a hospital, emergency room or surgical department who submits a statement or certification from such hospital, emergency room or surgical department confirming that the applicant is on-call surgical personnel, Tenn. Code. Ann. §55-4-222(i)
Trauma Physician Required Documentation: Statement of Certification from Board of Medical Examiners and from the Trauma Center in a hospital or other medical facility Tenn. Code. Ann. § 55-4-222(g)
Firefighters Plate Required Documentation: Proof of current or former* membership in a firefighting unit (retired firefighters in good standing are now eligible for this plate) Tenn. Code. Ann. § 55-4-241
Rescue Squad Plate Required Documentation: Badge as Member of Tennessee Association of Rescue Squads or list of eligible members from the Captain of the local Rescue Squad Tenn. Code. Ann. § 55-4-222(d)
SECTION 4. CERTIFICATION--Under Penalties of Perjury, I Hereby Certify This Information is Correct to the Best of My Knowledge.
_________________________________________________________________
SIGNATURE OF PERSON COMPLETING FORM DATE
SECTION 5. APPROVAL--THIS AUTHORIZATION FORM HAS BEEN _________ APPROVED __________ DENIED
_______________________________________________________________ (Tenn. Code Ann. § 55-2-107)
SIGNATURE OF COUNTY CLERK/DESIGNEE |
DATE |
|
|
RV-F1313901 (Rev. 7-12) |
|
TENNESSEE DEPARTMENT OF REVENUE
VEHICLE SERVICES DIVISION
AUTHORIZATION FOR THE SALE OF AN EMERGENCY VEHICLE
Form RV-F1313901--SIDE B
If requesting emergency plates use Side A
Complete this side only when transferring ownership of any government
owned emergency vehicle to any other individual or entity.
Physical possession of the vehicle CANNOT be transferred until this form is completed and processed by the appropriate County Clerk’s Office
SECTION 1. SELLER AND PURCHASER INFORMATION
NAME OF SELLER ______________________________________________________________________________________
ADDRESS______________________________________________________________________________________________
CITY ___________________________ STATE ________ ZIP _______________ TELEPHONE ______________________
NAME OF PURCHASER__________________________________________________________________________________
RESIDENTIAL ADDRESS_________________________________________________________________________________
CITY ___________________________ STATE ________ ZIP _______________ TELEPHONE ______________________
MAILING ADDRESS _____________________________________________________________________________________
(If different from above)
SECTION 2. VEHICLE INFORMATION (COMPLETE AS MUCH INFORMATION AS POSSIBLE)
MAKE ______________________ YEAR _____________ VIN__________________________________________________
CIRCLE TYPE: FIRE APPARATUS AMBULANCE POLICE VEHICLE OTHER _____________________________
IS VEHICLE BEING SOLD FOR SALVAGE__________
WILL VEHICLE BE REGISTERED OUT OF STATE _________IF SO, WHICH STATE ______________________________
SECTION 3. REQUIRED DOCUMENTATION (Tenn. Code. Ann. § 55-2-103)
THE FOLLOWING MUST BE SUBMITTED WITH THIS FORM BEFORE A CERTIFICATE OF TITLE IS ISSUED FOR THIS VEHICLE:
Bill of Sale
MSO or Certificate of Title
Payment Method (Cash, Check, Lien)
Name and Bona Fide Address of Purchaser
Copy of Driver License of Individual or Agent Authorized to Purchase Vehicle
SECTION 4. CERTIFICATION
UNDER PENALTIES OF PERJURY, I HEREBY CERTIFY THIS INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE.
_______________________________________________________________
SIGNATURE OF PERSON COMPLETING FORM DATE
SECTION 5. APPROVAL
THIS AUTHORIZATION FORM HAS BEEN ____APPROVED_____DENIED
_______________________________________________________________ (Tenn. Code Ann. § 55-2-107)
SIGNATURE OF COUNTY CLERK/DESIGNEE |
DATE |
|
|
RV-F1313901 (Rev. 7-12) |
|
