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Application for registration and licence for a motor-vehicle other than a motor-cycle Don, Wong Apr 4, 1921

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Full Text

 PROVINCE OF BRITISH COLUMBIA.
v
"MOTOR-VEHICLE ACT.
(Section 3.)
99
fl
Application for Registration and Licence for a Motor-
vehicle other than a Motor-cycle.
To the Superintendent of Provincial Police, Victoria, B.C.:
Application is hereby made, in triplicate, for registration and licence in respect of the motor-vehicle
described hereunder:
(1.) Made by
Particulars
of Motor-vehicle.
3t4£A-4fcJL A
(2.)  Style €1.
—r
(3.)  Serial No *^T.     (4.) Engine
m
(5.)  Number of cylinders 4$£»     (6.)  Weight in pounds ...
 te	
Z&A
:
*  fc
(7.) Carrying capacity «.	
(8.)  Dealers' selling-price, f.o.b. point of delivery in British Columbj
(9.) Age, showing year of make, date of purchase fromdealer, Jjfo length of ^time in use
/3Lo o
V
(10.)  Whether previously registered in the Province, and, if sjd, when
&nA...*
(11.)  Number of licence (if any) last
(12.) How and where to be used „t„
(13.) Name, in full, of owner
(14.) Full residential address of owner......
(15.)  Occupation of owner
The applicant now tenders the sum o
H5L-., being the fee prescribed under the " Motor-
vehicle Act," and hereby certifies to the correctness of sSl the statements herein contained.
Dated this
British Columbia.
is~-*4t,	
day of	
*jjjjjjjjjjj|H *jjjjjjjjj^^^^^H
(Signature of owner)
x
4B\ m-f    I
.-■cL-, 192/^ at...
f
(Signature of agent, if signed dy agent)
, (Full residential address of agent)
(Occupation of agent)
Note.—Application should be made in triplicate by the applicant on this form. One copy will be given back to the
applicant as a part of the licence issued thereon by the officer issuing such licence, who will send the original copy with
the duplicate of the licence to the Superintendent of Provincial Police at Victoria, B.C., and paste the third copy in the
Revenue Receipt Book immediately in front of the triplicate copy of the licence for audit and reference purposes. The
officer issuing the licence must also fill in on each copy of the application the number to correspond to the number of the
revenue receipt issued by him thereon.
^Sorm 1—15,000-10-20

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