Form Dsd Cdts-27 "Safety Inspection - Driver Training School Motor Vehicle Fleet" - Illinois

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Office of the Secretary of State
Commercial Driver Training School Division
Safety Inspection – Driver Training School Motor Vehicle Fleet
(Supplement – Additions and Deletions)
(This form must be completed and filed with the Driver Training School Division of the Office of the Secretary of State
Date of Inspection
within ten (10) days of any addition or deletion to the motor vehicle fleet of any driver training school)
(Please print or type)
Mo.
Day
Yr.
Name of Driver Training School
Street Address
City
State
ZIP
Phone
(000)
ADDITIONS
The applicant swears that all vehicles described herein are: (1) equipped with dual control devices, (2) registered in the name of the driver training school described herein, (3) in safe mechanical condition,
(4) properly identified in compliance with the rules and regulations relating to driver training school signs on owned or leased motor vehicles, and (5) properly insured in compliance with the Illinois Vehicle Code
and the rules and regulations providing therefor.
Inspection
1
Year
Make
Serial No.
License No.
Owned
Leased
Name and Address of Lessor (if leased)
Certificate
Initial of
Current ( )
(x)
(x)
Number
Inspector
2
3
4
5
6
7
8
9
10
11
12
The undersigned swears (affirms) that he/she is an authorized representative of the driver training school
(to be completed by Vehicle Inspection Station)
listed above; that he/she is authorized to execute this affidavit; and that the information contained herein is
true in substance and in fact.
Inspection Station Name: _______________________________________________________
Signature of Authorized Representative of Driver Training School
(
)
NOTE:
This schedule will not be accepted unless:
Address: _______________________________________________________
(1)
The above authorized representative is listed in the general information section of the driver
training school license application as an owner, manager, partner or corporate officer and
City: _______________________________________________________
has filed a personal history schedule with the Secretary of State.
(2)
Insurance certificates for all the vehicles listed in the additions section accompany this
supplementary schedule.
Office of the Secretary of State
Commercial Driver Training School Division
Safety Inspection – Driver Training School Motor Vehicle Fleet
(Supplement – Additions and Deletions)
(This form must be completed and filed with the Driver Training School Division of the Office of the Secretary of State
Date of Inspection
within ten (10) days of any addition or deletion to the motor vehicle fleet of any driver training school)
(Please print or type)
Mo.
Day
Yr.
Name of Driver Training School
Street Address
City
State
ZIP
Phone
(000)
ADDITIONS
The applicant swears that all vehicles described herein are: (1) equipped with dual control devices, (2) registered in the name of the driver training school described herein, (3) in safe mechanical condition,
(4) properly identified in compliance with the rules and regulations relating to driver training school signs on owned or leased motor vehicles, and (5) properly insured in compliance with the Illinois Vehicle Code
and the rules and regulations providing therefor.
Inspection
1
Year
Make
Serial No.
License No.
Owned
Leased
Name and Address of Lessor (if leased)
Certificate
Initial of
Current ( )
(x)
(x)
Number
Inspector
2
3
4
5
6
7
8
9
10
11
12
The undersigned swears (affirms) that he/she is an authorized representative of the driver training school
(to be completed by Vehicle Inspection Station)
listed above; that he/she is authorized to execute this affidavit; and that the information contained herein is
true in substance and in fact.
Inspection Station Name: _______________________________________________________
Signature of Authorized Representative of Driver Training School
(
)
NOTE:
This schedule will not be accepted unless:
Address: _______________________________________________________
(1)
The above authorized representative is listed in the general information section of the driver
training school license application as an owner, manager, partner or corporate officer and
City: _______________________________________________________
has filed a personal history schedule with the Secretary of State.
(2)
Insurance certificates for all the vehicles listed in the additions section accompany this
supplementary schedule.
DELETIONS
The applicant swears:
(1)
that the following vehicles are no longer operated by the Driver Training School named herein for driving training purposes.
(2)
that the safety inspection – insurance certification decal issued by the Secretary of State has been removed and destroyed.
Owned
Leased
1
Year
Make
Decal No.
License No.
(x)
(x)
Name and Address of Lessor (if leased)
2
3
4
5
6
7
8
9
10
11
12
13
14
15
CDTS-27.3

Download Form Dsd Cdts-27 "Safety Inspection - Driver Training School Motor Vehicle Fleet" - Illinois

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