BELMONT POLICE DEPARTMENT

Traffic Bureau

Application for Registration of Bicycle

Applicant Complete All Information Below:

I hereby make application for registration of bicycle in accordance with the provisions of Chapter 710, Acts of 1941.

Name:    ______________________________________________________________

                Last                                    First                                    MI

Address: ______________________________________________________________

               Street                                                                           Apt/Flr

             ______________________________________________________________

                Town                                        State                           Zip

Applicant Date of Birth:    ____________________    Tel.  (_____)_______________

Make of Bicycle: _________________  Model Number/Name: ___________________

Manufacturer's Serial Number: ____________________________________________

Color: ___________________________________________________________________

Other Identifiable Marks: _________________________________________________

_________________________________________________________________________

Signature of Applicant: _______________________________  Date: __________

After completing this form,  mail, along with a Self-Addressed, Stamped Envelope to:

   Belmont Police Department

   PO Box 130

   Belmont, MA 02478

Upon receipt of application, a decal will be mailed to the applicants address.  You may also register your bicycle online.  Click Here for more information.

This form printed from BELMONT PD ONLINE, www.belmontpd.org