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CITY OF LA PORTE <br />APPLICATION FOR REPLACEMENT WRECKER <br />(} Emergency Auto Wrecker Replacement Transfer Fee $25_00 Per Vehicle <br />(Note: Transfer fee can not be Pro Rated) <br />PERMIT EXPIRATION RF.1ViA?NS DECEMBER WT OF CURRENT YEAR <br />Company Name Shown on Permit: IM&M _�o67 L <br />1I_fI r.14-_ .\ ((7 <br />Applicant's Name: <br />Physical Address: <br />h <br />Mailing Address-. 0, -P>IX <br />E 1 is Je� Par & <br />Telephone: D f d J �P <br />Discontinued Wrecker. <br />Year <br />Liist_Wrmker Changg(s) Belaw: <br />Motor/I.b. # License * <br />Replacement Wrecker: <br />RN Mk&if <br />Year MakelModel Motor/I.D. # License tE <br />If new Wrecker is not owned by the Applicant, list vehicle owner's name and address: <br />I) <br />Name Address <br />City/Stata/Zip <br />NOTE: If the wrecker is operated under the terms of a contract with some company <br />other than the owner, a copy of the contract shall be attached to this application. <br />I hereby agree to obey the provisions of the city's rules and regulations, ordinances and statutes <br />applicable to motor vehicles and understand that upon my failure to so obey such lards that nay pennit may <br />be revoked or suspended without notice. <br />