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Attachment II -- 251 NAC, Chapter 4 -- SAMPLE

MISUSE OF PERMANENT PLATE REPORT

To the Director of the Department of Motor Vehicles:

As provided in 251 NAC 4-007.07 and Neb. Rev. Stat. 60-305.16, I am reporting misuse of a permanent plate. I was able to gather the following information:

DATE OBSERVED:

TIME:

LOCATION:

PLATE NUMBER:

VEHICLE MAKE AND MODEL:

VIN:

NAME OF DRIVER:

OPERATOR S LICENSE NUMBER AND STATE OF ISSUANCE:

IDENTITY OF MOTOR CARRIER / OWNER / REGISTRANT OF THE VEHICLE OBSERVED:

COMPANY:

ADDRESS:

BRIEF DESCRIPTION OF THE TYPE OF MISUSE OF THE PERMANENT PLATE AND CIRCUMSTANCES:

Plate was attached to a vehicle to which the plate was not issued. Plate on vehicle operating on the highways was an inactive plate. Additional comments:

SIGNATURE:

LAW ENFORCEMENT AGENCY:

BADGE NUMBER:

DATE:

CHECK HERE IF REPORTING PARTY IS DEPARTMENT OF MOTOR VEHICLES AUDITOR

1/2000

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