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Richard Musgrove
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Posts: 4284
Joined: Wed Apr 03, 2019 7:05 pm
Primary Assignment: Professional Standards Bureau
#389982
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LOS SANTOS POLICE DEPARTMENT
TRAFFIC DIVISION

APPLICATION FOR WINDOW TINT EXEMPTION
INDIVIDUAL EXEMPTION FORM


PART I.
  1. FIRST NAME: JOSEPH
  2. SURNAME: MESSANO
  3. ADDRESS (NUMBER & STREET): 3201 WEST MIRROR DRIVE
  4. CITY: LOS SANTOS
  5. STATE: San Andreas


VEHICLES TO BE REGISTERED FOR EXEMPTION:
Maximum of 2
  • Vehicle: VAPID GUARDIAN RV
    Plates: LPQ095
  • Vehicle: Make & Model
    Plates: XXX###



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. **

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: 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:
Sign Name in Full

X JOSEPH MESSANO

Date:
14/MAY/2022

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James Nickleson
Retired Police Sergeant I
Retired Police Sergeant I
Posts: 1240
Joined: Sun Oct 08, 2017 6:43 am
Primary Assignment: Traffic Division
Serial No.: 099
#393564
Joseph Messano wrote: Sat May 14, 2022 2:11 pm
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LOS SANTOS POLICE DEPARTMENT
TRAFFIC DIVISION

To Mr Messano,
  • Upon review of your tint exemption application, your application has been marked as DENIED due to the following items:
    • No specified reason for request in section 2.
    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.

Respectfully,

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James Nickleson
Traffic Supervisor
Traffic Division
Los Santos Police Department