CITY OF PARKVILLE ▪ 8880 Clark Avenue ▪ Parkville, MO 64152 ▪ (816) 741-7676 ▪ FAX (816) 741-0013
Golf Cart / Low Speed Vehicle Registration
1. Type of Registration
Registration Type (check one) Vehicle Type (check one)
New Golf Cart
Renewal Low Speed Vehicle
2. Registration Information
Owner(s) Vehicle
Name: _________________________________ VIN #: ________________________________
Address: _______________________________ Make & Model: _________________________
City, State, Zip: __________________________ Year: _________________________________
Phone: ________________________________ Color: ________________________________
Cell Phone: _____________________________ Storage Location: _______________________
Email: _________________________________ Insurance Policy #: ______________________
Driver’s License #: _______________________ Insurance Company: ____________________
Driver’s License State: ____________________ Insurance Phone: _______________________
3. Checklist of Submittals Required at Time of Application
Payment (cash, check or money order)
Completed Form
Copy of Valid Driver’s License
Copy of Motor Vehicle Insurance
Copy of Current Inspection for Vehicles 2+ years and Signed Certificate of Satisfactory Inspection
Signed Municipal Code Section 362 regarding Operation Regulations (see page 2)
4. Acknowledgement and Authorization Signature
I (we), the undersigned, do hereby authorize submittal of this application and associated documents and
certify and affirm by my signature that all information I have provided is true and correct. I do hereby
agree to abide by and comply with all applicable Parkville Municipal Codes and conditions of approval. I
further understand that any violations from the provisions of said codes and conditions of approval shall
constitute cause for retraction of this application. I understand this application is non-transferable and that
changes may require submittal of a new application. I understand that in any case this application must
be renewed every two years.
Owner Signature: ________________________________________ Date: ____________
For City Use Only
Application accepted as complete by: ______________________________________ Date: _______________
License Fee $_____________ Date paid: _____________ By: Check # ______ M.O. #______ Cash
Payment made by: ____________________________ Received by: ________________________________
1. Original to Parkville 2. Copy to Police Department 3. Copy to Applicant
Date Submitted: ________
Revised March 2014
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