- Natalia Campos
- Posts: 2406
- Joined: Wed Jul 10, 2019 7:32 pm
- Primary Assignment: Field Training Program
- Serial No.: 18213
By Natalia Campos -
- Fri Jan 21, 2022 11:05 am
#364458
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: N/A
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. **
ACCESS
ACCESS
ACCESS
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: N/A
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:
SIGNATURE IN FULL NAME
X ARTURO VASQUEZ
Date:
21/JAN/2022
Note: Had been pulled over on 21st Jan 2022 and the Traffic Division motor officer informed me I shall file a tint exemption request on basis that as a D Platoon member, I'm very private about my identity and my workplace, and it should be an easy signoff due to the nature of my profession. If this is not the case, then please let me know, but given the Division that employs these exemptions recommended me to seek an exemption on that basis, I am.
CAPTAIN II NATALIA CAMPOS
Coordinator, Field Training Program
Los Santos Police Department — "To Protect and to Serve"
SERGEANT II ARTURO VASQUEZ
Squad Leader, D Platoon (SWAT), Metropolitan Division
LOS SANTOS POLICE DEPARTMENT
TRAFFIC DIVISION
TRAFFIC DIVISION
APPLICATION FOR WINDOW TINT EXEMPTION
INDIVIDUAL EXEMPTION FORM
INDIVIDUAL EXEMPTION FORM
PART I.
- FIRST NAME: ARTURO
- SURNAME: VASQUEZ
- ADDRESS (NUMBER & STREET): 226 BARBARENO ROAD
- CITY: LOS SANTOS
- STATE: SA
VEHICLES TO BE REGISTERED FOR EXEMPTION:
Maximum of 2
- Vehicle: Karin Sultan RS N/A
Plates: NO KIDS - Vehicle: N/A
Plates: N/A
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: N/A
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. **
ACCESS
ACCESS
ACCESS
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: N/A
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:
SIGNATURE IN FULL NAME
X ARTURO VASQUEZ
Date:
21/JAN/2022
CAPTAIN II NATALIA CAMPOS
Coordinator, Field Training Program
Los Santos Police Department — "To Protect and to Serve"
SERGEANT II ARTURO VASQUEZ
Squad Leader, D Platoon (SWAT), Metropolitan Division