Form Blc-51 - Application For Red Light Permit For County Emergency Management Coordinator Page 2
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1
2Motor Vehicle
Business Licensing Services Bureau
P.O. Box 168
Commission
Trenton, New Jersey 08666-0168
Phone: (609) 292-6500 ext.5095
APPLICATION FOR RED LIGHT PERMIT
FOR
COUNTY EMERGENCY MANAGEMENT COORDINATOR
Date______________________
I,_____________________________________________________________________________________________
(print name and address of applicant)
hereby apply for a Red Light/Siren Permit for the following vehicle:
NJ Driver License Number________________________________________________________________________
Name of Registered Owner/Lessee__________________________________________________________________
Street Address__________________________________________________________________________________
City, County, State, Zip ___________________________________________________________________________
Vehicle make, model, year_________________________________________________________________________
Registration Plate No.________________________ VIN________________________________________________
Describe use of vehicle
Signature of Applicant_____________________________________ Title____________________________________
Organization_____________________________________________ Corp Code______________________________
THIS SECTION IS TO BE COMPLETED BY THE DIRECTOR OF THE BOARD OF CHOSEN FREEHOLDERS:
I,________________________________________________, the Director of the Board of Chosen Freeholders for
___________________________ County, affix my signature in approval of the above application to be granted a permit
for the use of a red light/siren on the vehicle described above.
________________________________________________________
Director, Board of Chosen Freeholders
THIS SECTION IS TO BE COMPLETED BY THE DIRECTOR OF THE STATE OFFICE OF EMERGENCY MANAGEMENT:
I affix my signature in agreement to the approval of the County Emergency Management Coordinator for
the above applicant to be granted a permit for the use red light/siren.
___________________________________________________
Director, State Office of Emergency Management
ATTACH THE FOLLOWING: A copy of the registration for the vehicle described above; a copy of the lease
agreement/contract if the vehicle is leased; the letter of request from your municipality.
MVC Web Site
BLC-51 (R12/08)
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