Lost / Stolen Decal & Hanging Guest Pass Affidavit

Lost / Stolen Decal & Hanging Guest Pass Affidavit

Member Name*

Member Division-Block-Lot*

Member Phone Number

Phone

Member Email Address

Member Mailing Address

Date of Report*

What needs to be reported and voided?*

Select

Vehicle License Plate #*

Watercraft ID #*

Trailer License Plate #*

Vehicle Decal #

Vehicle Placard #

Watercraft Decal #

Trailer Decal #

Hanging Guest Pass #

Item is being reported*

Select

If other, please explain*

Date item was/was not removed*

This an also be the date the member noticed it needed to be replaced.

Any member comments?

Member Digital Signature*

By typing my name below, I acknowledge that any Decal, Placard or Hanging Pass reported lost or stolen or other will be considered voided, logged as such and reported to Security. Any reported voided decal or pass found in use in any LCMC park, will be towed immediately at the owner's expense.

If a replacement is issued, how you would like to receive it?

Select

Send me a copy of my responses

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