Motor Vehicle Commission Business Licensing Services Bureau P.O. Box 168 Trenton, New Jersey 08666-0168 Phone:(609) 292-6500 ext.5095 APPLICATION FOR RED LIGHT AND/OR SIREN PERMIT Dat e I,_____________________________________________________________________________________________ (print name and address of applicant) hereby apply for a Red Light/Siren Permit for the following vehicle: * N.J. Driver License Number Name of Registered Owner/Lessee Street Address City, County, State and Zip Describe use of ve hicle Signature of Applicant____________________________________________ Title_________________________ Organization_________________________________________________ Corp Code______________________ Please check one in each section: Paid Employee Vehicle provided by Department Volunteer This section is to be completed by the MAYOR OR CHIEF EXECUTIVE OFFICER of the governing body of the municipality being served by the police department, fire company, first aid squad or emergency equipment manufacturer. I,_______________________________________, have read the information on the reverse side of this application please print pertaining to red light/siren permit for the vehicle described above and believe the applicant qualifies for a permit. *Current Blue Light permit must be surrendered with this application. Signature Title ATTACH THE FOLLOWING: A copy of the registration for the vehicle described above; if the vehicle is leased, a copy of the lease agreement. Governing Body Address City, County, Zip Information pertaining to red light/siren permits is on the back of this application. BLC-56 (R12/08) MVC Web Site http://www.njmvc.gov American LegalNet, Inc. www.FormsWorkFlow.com INFORMATION PERTAINING TO RED LIGHT/SIREN PERMITS ELIGIBLE: Applicants for permits authorizing the use of red lights and/or sirens pursuant to N.J.A.C. 13:24 et seq., may be considered eligible only if the vehicle intended to display the red light/siren is: Owned by and registered in the name of the current chief or first assistant chief of a volunteer fire company, or chief officer of a first aid or rescue squad; owned or leased by an organization engaged in the manufacturer and/or sale of emergency vehicle or equipment and operated by an employee thereof only for the purposes of demonstration or delivery. POSSESSION AND EXHIBITION OF PERMIT: The permit issued must be in the possession of the operator at all times when the red lights and/or sirens are displayed on the vehicle and must be exhibited upon the request of any law enforcement official. PERMIT VALIDITY; CANCELLATION: Permits are valid for two (2) years from the date of issuance and are nontransferable. The Chief Administrator of the Motor Vehicle Commission may cancel or revoke a permit for the following reasons: expiration/termination, for any reason, of term of office or contract which entitled the holder to the permit; the sale, transfer, destruction, or termination of lease for the vehicle for which the permit was issued, a violation of any of the conditions applying to such permit as stated in N.J.A.C. 13:24 et seq.; and/or upon the conviction of the operator for any violation of Title 39, Motor Vehicle and Traffic Regulations involving the use if lights and/or sirens. The permit holder must surrender cancelled or revoked permits for red lights/sirens to the Motor Vehicle Commission within 10 days of the cancellation/revocation. MOUNTING OF LIGHTS: Red lights placed on a vehicle owned by and registered in the name of the current chief or first assistant chief of a volunteer fire company, or chief officer of a first aid or rescue squad shall be mounted only on the exterior of the vehicle and will consist of not more than two (2) magnetic base type removable lights. If only one (1) red light is used, it will be mounted on the center of the roof, or the left windshield column. If two (2) lights are used, they will be mounted on either side of the roof at the front of the vehicle directly behind the top of the windshield or on each windshield column. American LegalNet, Inc. www.FormsWorkFlow.com