APPLICATION FOR WINDOW TINT EXEMPTION
INDIVIDUAL EXEMPTION FORM
FIRST NAME: Ryan
ADDRESS (NUMBER & STREET): 1133 Palomino Avenue
CITY: Los Santos
STATE: San Andreas
VEHICLES TO BE REGISTERED FOR EXEMPTION: Maximum of 2
Vehicle: 2022 Obey E-GT Plates: NVA454
MEDICAL DIAGNOSIS FOR EXEMPTION: Skip if not applicable | (( Convert cb to cbc for a checkmark ))
Chronic actinic dermatitis/actinic reticuloid
Xeroderma (pigmentosa) pigmentosum
Severe drug photosensitivity provided that the course of treatment causing the photosensitivity is expected to be of prolonged duration
Photophobia associated with an ophthalmic or neurological disorder
If other condition or disorder causing severe photosensitivity in which a person is required to be shielded from sun rays for medical reasons, please fill the field in below: Other: -
EVIDENCE OF MEDICAL DIAGNOSIS: Medical diagnosis must provide the certified medical provider's name, examination date (must be within one month of from the date this form is submitted to the LSPD), and clinic name. Certified medical professional must have a San Andreas certification.
** On 15th October, Ryan Aguero heads for an appointment at Vespucci's Ophthalmology related to his eye condition. Aguero provides the necessary signed document for the diagnosis. | Photophobia, prescription glasses whenever light is too bright, 2 x Imidazyl Eye Drops per day **
EXEMPTION FOR CREDIBLE THREAT: Credible threat is gauged by submitting a Crime Complaint Report to the Area Detectives Division. Once the Crime Complaint Coordinator has reviewed the presented evidence, they will inform the Traffic Division of approval or dismissal of the application for window tint exemption.
I confirm I have emailed the Crime Complaint Coordinator with a Crime Complaint regarding a credible threat. Date Complaint Filed: DD/MMM/YYYY PART III.
I certify and affirm that all information presented in this form is true and correct, that any documents, including supporting documentation that I have presented to the Los Santos Police Department are true, accurate, and genuine. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal offense.
Upon review of your tint exemption application, your application has been marked as PENDING for the following items:
We can't process the tint exemption due to the vehicle being uninsured.
At this time, you may elect to either withdraw your application or provide the additional information required within the next forty-eight (48) hours. Should you have any question, concern or require any information in regards to this decision, please do not hesitate to contact a Senior Traffic Officer, Traffic Division.
Los Santos Police Department
We are pleased to inform you that all pre-approval checks have now been resolved and that your application for tint exemptions has been APPROVED. Within this letter will be contained the certifications for the approved vehicles and their level of tint exemption.
Please keep all certificates within the glove box of the matching vehicle and provide the document to any Law Enforcement Officer if detained in connection with the vehicle. Upon expiry of the certification, a new application for tint exemption may be made.
Los Santos Police Department