LOS SANTOS
-
Julian Harding
- Police Officer III+1
- Posts: 223
- Joined: Tue Feb 21, 2023 4:10 pm
- Badge Number: 130129
- Primary Assignment: Traffic Division
- Serial No.: 130129
By Julian Harding -
- Tue Jan 16, 2024 6:57 am
#487081
PART I.
VEHICLES TO BE REGISTERED FOR EXEMPTION:
Maximum of 2
PART II.
MEDICAL DIAGNOSIS FOR EXEMPTION:
Skip if not applicable | (( Convert cb to cbc for a checkmark ))
Abinism
Chronic actinic dermatitis/actinic reticuloid
Dermatomyositis
Lupus erythematosus
Porphyria
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.
** ATTACHED DOCUMENTS IF APPLICABLE. **
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.
Signature of Vehicle Registrant:
Sophie Kaczynski
X Sophie Kaczynski
Date:
16/JAN/2024
POLICE OFFICER III+1 JULIAN HARDING (#130129)
Traffic Division, Specialized Enforcement Section | Motor Officer
Field Training Program | Field Training Manager
Traffic Division | EVOC Instructor
Firearms Licensing Divison | Senior Firearms Licensing Officer
Recruitment and Employment Division | Drill Instructor
Los Santos Police Department — "To Protect and to Serve"
LOS SANTOS POLICE DEPARTMENT
TRAFFIC DIVISION
TRAFFIC DIVISION
APPLICATION FOR WINDOW TINT EXEMPTION
INDIVIDUAL EXEMPTION FORM
INDIVIDUAL EXEMPTION FORM
PART I.
- FIRST NAME: Sophie
- SURNAME: Kaczynski
- CONTACT NUMBER: 20475
- ADDRESS (NUMBER & STREET): 3585 Didion Drive
- CITY: Los Santos
- STATE: San Andreas
VEHICLES TO BE REGISTERED FOR EXEMPTION:
Maximum of 2
- Vehicle: Declasse Mamba
Plates: LS2312 - Vehicle: Vapid Caracara
Plates: LKR239
PART II.
MEDICAL DIAGNOSIS FOR EXEMPTION:
Skip if not applicable | (( Convert cb to cbc for a checkmark ))
Abinism
Chronic actinic dermatitis/actinic reticuloid
Dermatomyositis
Lupus erythematosus
Porphyria
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.
** ATTACHED DOCUMENTS IF APPLICABLE. **
Sophie Kaczynski Medical Report.pdf: show
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.
Signature of Vehicle Registrant:
Sophie Kaczynski
X Sophie Kaczynski
Date:
16/JAN/2024
Last edited by Julian Harding on Thu Jan 18, 2024 5:41 am, edited 2 times in total.
POLICE OFFICER III+1 JULIAN HARDING (#130129)
Traffic Division, Specialized Enforcement Section | Motor Officer Field Training Program | Field Training Manager Traffic Division | EVOC Instructor Firearms Licensing Divison | Senior Firearms Licensing Officer Recruitment and Employment Division | Drill InstructorLos Santos Police Department — "To Protect and to Serve"
