University Police Department
VEHICLE REGISTRATION FORM
DRIVER
NAME
DL NUMBER
DOB
CLASS
ADDRESS
CITY STATE ZIP
OLLU ID NUMBER
BUSINESS PHONE NUMBER
OFFICE / DORM RM #
CLASSIFICATION
RESIDENT COMMUTER WEC FACULTY STAFF OTHER
VEHICLE #1
DECAL NUMBER
LICENSE PLATE NUMBER
STATE
VIN #
YEAR
MAKE
MODEL
COLOR
VEHICLE STYLE
2-DOOR 3-DOOR 4-DOOR SUV PICKUP VAN MOTORCYCLE
VEHICLE #2
DECAL NUMBER
LICENSE PLATE NUMBER
STATE
VIN #
YEAR
MAKE
MODEL
COLOR
VEHICLE STYLE
2-DOOR 3-DOOR 4-DOOR SUV PICKUP VAN MOTORCYCLE
DO YOU REQUIRE HANDICAP PARKING?
YES NO IF YES, FILL OUT INFORMATION BELOW
HANDICAP PLACARD/LICENSE PLATE/DISABLED VETERAN PLATE
DL
HC PLACARD /
LP/ DV LP #
REGISTERED
OWNER
NOTE: ONLY ONE PERSON CAN BE REGISTERED TO A HC PLACARD/LP OR DV LP. UNDER TEXAS TRANSPORTATION CODE
681.011 IT IS A MISDEMEANOR OFFENSE PUNISHABLE BY A FINE OF $500 FOR ANY PERSON TO USE A HC PLACARD/LP OR DV
LP THAT IS NOT REGISTERED TO THEM TO PARK IN HANDICAP PARKING. UNDER TEXAS TRANSPORTATION CODE 681.0111 IT
IS A CLASS A MISDEMEANOR OFFENSE FOR ANYONE TO KNOWNINGLY POSSESS OR USE A COUNTERFEIT HC PLACARD/LP OR
DV LP TO PARK IN HANDICAP PARKING SPACES.
+-
FOR OFFICE USE ONLY
INSURANCE PROVIDER
EXPIRATION DATE VERIFIED BY
I acknowledge this information is true and accurate. I also understand Our Lady of the Lake University
is not responsible for theft / vandalism of my vehicle or personal property inside my vehicle.
Driver Signature
Date
Providing a Safe Environment for our University Community Through Commitment to Duty, Mission, and Service
OLLUPD-FM 401 (REV. 03/16 DCJ)