Request for LISE
Marine Decal
Please
print this form, complete and send to:
1211
Island Drive, Lummi Island, WA 98262.
(Enclose
check for $5 per boat - skiffs, etc. are free)
Name:
_____________________________________
(please print)
Property:
Lot: ______ Division: ______ Block (if applicable): ______
Telephone:
__________________
Number
of Decals Requested: ______ Total Submitted: $______
Description
of Boat(s) _______________________________________________________
__________________________________________________________________________
Address
for delivery of decal(s): _____________________________________________
I
have read and will abide by the regulations as set out in the Rules and
Regulations of L.I.S.E.C.C., Section
5.2.5. and Policy Statement #9.
Signature:
_____________________________
Date:
______________________
For
Office Use Only:
Date:
___________________ Decal #: _____________ Issued By: ____________________
|