Power of Attorney Disabled Person

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Power of Attorney Disabled Person Powered By Docstoc
					                                                     DMV SUPPLY REQUEST FORM
                                                   DMV Offices and Commission Agents
                                                                 Page 1
Page 1 Instructions:
1. Enter your information in the boxes on the top row.
2. Do NOT enter anything in the SAR# or Control # fields; those are for DMV Supply use ONLY.
3. If you want to order an entire unit (eg., 2009 Vehicle Tabs), enter the quantity in the "Units" column.
4. If you want to order a smaller quantity (eg. 10 Gov't Exempt Plates), enter the quantity in the "Single" column.
5. HCP Parking Permits and Assigned ID without VIN must be ordered in the "Single" column
6. Forms F-817 through F-822 must be ordered by "Units" only.
7. If an item is not on the list, type or write it on the bottom line of Page 2.
8. If you Fax (269-5569) or email (DOA.DMV.Supply@alaska.gov) your order by MONDAY,
      it will be mailed/delivered by FRIDAY.

Page 2 Instructions:
1. Do NOT enter anything in the fields on the top row. When you complete the top row on Page 1, it will carry forward to Page 2
  Note: If you are hand-writing in the information, you will need to white out the "0" in each field and enter the correct information.
2. Do NOT enter anything in the SAR# field; that's for DMV Supply use ONLY.
3. All items must be requested in whole units ONLY except Manuals; if you want fewer than a box, enter the amount in the
    "Single" column.
4. If an item is not on the list, type or write it in an empty row.




       Form 805 BP (Rev. 03/2011)                                                        C:\Docstoc\Working\pdf\cf322c4f-f051-4b04-8e5f-a866b9a640c7.xls
                                                     DMV SUPPLY REQUEST FORM
                                                   DMV Offices and Commission Agents
                                                                 Page 1

                                                                                                               Date Ordered:
           Loc #                   Location Name                            Person Placing Order
                                                                                                                        SAR#
                                                                 Unit Desc     Quantity Ordered                            Control #
           Item #                    Description                 Qty    Type Units Single TOTAL                    Begin               End
         TV-2011     Tabs, Vehicle - 2011                        200         box
         TV-2012     Tabs, Vehicle - 2012                        200         box
         TV-2013     Tabs, Vehicle - 2013                        200         box
         D-520-11    Tab, Boat, non-power - 2011                  50         box
         D-520-12    Tab, Boat, non-power - 2012                  50         box
         D-520-13    Tab, Boat, non-power - 2013                  50         box
         D-520-14    Tab, Boat, non-power - 2014                  50         box
         D-530-11    Tab, Boat, power - 2011                      50         box
         D-530-12    Tab, Boat, power - 2012                      50         box
         D-530-13    Tab, Boat, power - 2013                      50         box
         D-530-14    Tab, Boat, power - 2014                      50         box
         D-515       Decal, Snowmachine                           50         box
         TS-2011     Tabs, Snowmachine - 2011                    200         box
         TS-2012     Tabs, Snowmachine - 2012                    200         box
         TS-2013     Tabs, Snowmachine - 2013                    200         box
         TS-2014     Tabs, Snowmachine - 2014                    200         box
         TS-2015     Tabs, Snowmachine - 2015                    200         box
         TS-2016     Tabs, Snowmachine - 2016                    200         box
         TS-2017     Tabs, Snowmachine - 2017                    200         box
         TP-2011     Tabs, Seasonal/Pollution - 2011             200         box
         TP-2012     Tabs, Seasonal/Pollution - 2012             200         box
         TP-2013     Tabs, Seasonal/Pollution - 2013             200         box
         P-200-LF    Plate, Vehicle - Last Frontier         50     pairs     box
         P-201       Plate, Motorcycle/Trailer (small)      100        ea    box
         P-202       Plate, Trailer (large)                 100        ea    box
         P-203       Plate, Government Exempt               50     pairs     box
         P-204       Plate, Charitable Exempt               50     pairs     box
         P-205       Plate, Handicap                        50     pairs     box
         P-206       Plate, Disabled Vet with Logo          50     pairs     box
         P-207       Plate, Disabled Vet without Logo       50     pairs     box
         P-208       Plate, Historical                            1           ea
         P-209       Plate, Collectors                            1           ea
         P-210       Plate, Air Force                             1           ea
         P-211       Plate, Army                                  1           ea
         P-212       Plate, Coast Guard                           1           ea
         P-213       Plate, Navy                                  1           ea
         P-214       Plate, Marine                                1           ea
         P-215       Plate, National Guard                        1           ea
                     Plate,                                       1           ea
         P-223-LF    Plate, Sample, Last Frontier           100        ea    box
         P-223-50    Plate, Sample, 50th Anniversary        100        ea    box
         F-862-14    HCP PERM Parking Permit - 2014               1           ea
         F-862-15    HCP PERM Parking Permit - 2015               1           ea
         F-863-11    HCP TEMP Parking Permit - 2011               1           ea
         F-863-12    HCP TEMP Parking Permit - 2012               1           ea
         A-5000      New Vehicle Pamphlet-DEC                    100         pkg
         A-5001      New Vehicle Sticker-DEC                      25         pkg
         F-801       Receipt for Fees                            100         pkg
         F-802       Assigned ID (without VIN)                    1           ea
         F-802 B     Assigned ID (with VIN)                       25         pkg
         F-817       One-Way Trip Permit                          50         pkg
         F-835       Certificate of Title                        200         pkg
         F-840       Boat Registration                           200         pkg
         F-836       Vehicle Registration                        200         pkg
         F-852       Temporary Permit                             25         pkg



Form 805 BP (Rev. 06/2011)                                                                 C:\Docstoc\Working\pdf\cf322c4f-f051-4b04-8e5f-a866b9a640c7.xls
                                                              DMV SUPPLY REQUEST FORM
                                                            DMV Offices and Commission Agents
                                                                          Page 1

        0                                   0                                                                                               Date Ordered:          01/00/00
    Loc #                             Location Name                      Person Placing Order
                                                                                                                                               SAR#
                                                            Unit Desc Quantity Ordered                                                                Unit Desc Qty Ordered
   Item #                            Description            Qty Type Units Single TOTAL          Item #                   Description                 Qty Type Units TOTAL
Month Tabs                                                                                      Forms
T-101            Tabs, Month - JAN                          200   box                           F-841B    Appl-Boat (1 part)                          200    pkg
T-102            Tabs, Month - FEB                          200   box                           F-841S    Appl-Boat (short)                           100    pkg
T-103            Tabs, Month - MAR                          200   box                           F-478     Appl-Drivers License/ID                     500    pkg
T-104            Tabs, Month - APR                          200   box                           F-812     Appl-Title & Registration (1 part)          500    pkg
T-105            Tabs, Month - MAY                          200   box                           F-821     Vehicle Transaction Appl (short form)       500    pkg
T-106            Tabs, Month - JUN                          200   box                           A-7001a Add'l Comm Veh Info-PRISM vehicles             50    pad
T-107            Tabs, Month - JUL                          200   box                           F-12-209 Accident Report                              100    pad
T-108            Tabs, Month - AUG                          200   box                           F-415     Appl-Commercial Drivers License              50    pad
T-109            Tabs, Month - SEP                          200   box                           F-404C    Appl-Limited Lic Non-Comm                   100    pkg
T-110            Tabs, Month - OCT                          200   box                           F-412     Appl-School Bus License                     100    pad
T-111            Tabs, Month - NOV                          200   box                           F-466     Certificate of Insurance                    100    pad
T-112            Tabs, Month - DEC                          200   box                           F-419     Driver Record Request                       100    pad
Manuals                                                                                         F-450     General Release                             100    pad
M-300            Driver Manual                              200   case                          F-478A    Interpreter Information                     100    pad
M-301            Motorcycle Manual                          320   case                          F-401     Notice of Change of Address                 100    pad
M-302            CDL Manual                                 50    case                          F-433     Parent/Guardian Consent for a Minor         100    pad
M-303            Boat Manual                                120   case                          F-447     Request for Administrative Hearing          100    pad
DDL Supplies                                                                                    F-417     Road Test - CDL                             100    pad
DDL-020          DDL Cards                                  500   box                           F-465     Settlement Agreement and Release            100    pad
DDL-ZXP-LC       DDL Laminate - clear (bottom)              625   roll                          F-458     Road Test - Class D                         200    pkg
DDL-ZXP-LS       DDL Laminate - secure (top)                625   roll                          F-424     Withdraw Parental Consent                   100    pad
DDL-ZXP-R        DDL Ribbon                                 500   roll
DDL-ZXP-T        DDL Transfer Film                          625   roll                          F-838     Aff of Abandoned/Sold Mobile Home           100    pad
DDL-ZXP-A        DDL Adhesive Cleaning Rollers               1    ea                            F-848     Aff of Boat Ownership                       100    pad
DDL-ZXP-C        DDL Cleaning Kits                           1    ea                            F-827     Aff of Estate <$100,000                     100    pad
Informational Cards & Brochures                                                                 F-819     Aff of Homebuilt Trailer                     50    pad
A-4000           Your Teen & DMV                            100   pkg                           F-809     Aff of Lost, Destroyed, Stolen Title        100    pad
A-4002           Organ Donor Info                           100   pkg                           F-859     Aff of Possession-Work/Storage Lien         100    pad
A-4007           Disability Parking is a Privilege          100   pkg                           F-843     Aff of Repossession                         100    pad
A-4008           Provisional License For Teens              100   pkg                           F-861     Appl-Disabled Parking                       100    pad
A-4009           Customer Survey                            200   pkg                           F-803     Appl-Personalized License Plates            100    pad
A-4012           Hazmat Brochure                            50    pkg                           F-803V    Appl-Personalized Vet Plates                100    pad
A-4015           DUI Tickets are Bad & Costly               100   pkg                           F-842     Assigned Hull ID Number                     100    pad
A-4016           Turning 21                                 100   pkg                           F-804     Batch Forms Report                          100    pad
A-4017           WebSTAR Brochure                           100   pkg
A-4018           Mandatory Insur-Financial Responsibility   100   pkg                           F-811     Cert of Vehicle Inspection                  100    pad
                                                                                                F-830     Certificate of Amateur Radio Plates          50    pad
                                                                                                F-818     Charitable Exempt Affidavit                 100    pad
                                                                                                F-825     Claim of Ownership of Abandoned Vehicle 100        pad
                                                                                                F-813     Dealer Aff of Vehicle Held in Inventory     100    pad
                                                                                                F-846     Heavy Vehicle Use Tax Declaration           100    pad
                                                                                                F-828     Military Affidavit                           50    pkg
                                                                                                F-851     Motor Vehicle Record Request                100    pad
                                                                                                F-824     No/Inadequate Proof of Ownership            100    pad
                                                                                                F-849                                                  100
                                                                                                          Notice of Acquistion, Intent to Dismantle or Junk pad
                                                                                                F-820     Notice of Transfer Pending                  100    pad
                                                                                                F-826     Notification of Impound and Sale             50    pad
                                                                                                F-839     Odometer Disclosure Statement                50    pad
                                                                                                F-847     Power of Attorney                           100    pad
                                                                                                F-829     Reconstructed Vehicle Affidavit             100    pad
                                                                                                F-853     Request for Refund                          100    pad
                                                                                                F-808     Sale of Snowmachine or ATV                   50    pkg
                                                                                                F-807     Senior Citizen Exempt Affidavit             100    pad
                                                                                                F-866     Special Traction Permit                      1      ea




        Form 805 BP (Rev. 06/2011)                                                                         C:\Docstoc\Working\pdf\cf322c4f-f051-4b04-8e5f-a866b9a640c7.xls

				
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Description: Power of Attorney Disabled Person document sample