ANNUAL GOLF CART PERMIT APPLICATION
No person shall operate a motorized golf cart on roadways in the City unless granted a permit under Section 82-300
of the Municipal Code. Registration does not exempt compliance with applicable local, state and federal laws.
Return completed form with proof of insurance to the New Richmond Police Department.
Name
Address
Day Phone # Email
Driver’s License # State of Issuance
Expiration Date Insurance Policy #
Golf Cart Information
VIN Number and/or Serial Number
Year Make/Model Color
By signing below, I hereby certify under penalties of law that all information is true and correct. I will
comply with Ordinance Section 82-300, Art IX Golf Carts of the City of New Richmond’s Municipal
Code and Wisconsin State Statutes.
Applicant’s Signature Date
Office Use Only
Required Inspection Items:
One (1) Headlight One (1) Taillight
Rearview Mirror Seatbelts
Reflective Slow Moving Vehicle Sign
Pass / Fail Inspected by: Date
Received By Date
Permit No Expiration Date 11/20/2020 Fee: $25.00
Submit completed form to lhagen@newrichmondwi.gov.
Call (715) 246-6667 to make an inspection appointment.
click to sign
signature
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