Please complete form, attach Insurance Policy and submit.Applicant First Name: (required) *Applicant Last Name: (required) *Applicant First Name:Applicant Last Name:Mailing Address:Address: (required) *Apartment, suite, etc:City: (required) *State: (required) *ZIP Code: (required) *Phone Number: (required) *Email: (required) *County Property Address: Address: (required) *City: (required) *State: (required) *Zip Code: (required) *Moped, Motorcycle or ATV DescriptionVehicle 1Year:Make/Model:Serial Number:Insurance Company:Policy Number:Expiration Date:Upload Copy of PolicyChoose FileNo file chosenDelete uploaded fileVehicle 2Year:Make/Model:Serial Number:Insurance Company:Policy Number:Expiration Date:Upload Copy of Policy (if different from Vehicle 1)Choose FileNo file chosenDelete uploaded fileI have read and understand the Currituck County Beach Driving Ordinance (Chapter 10, Currituck County Code of Ordinances) as adopted and amended and have uploaded a copy of my insurance policy showing current liability coverage on the ATV(S).By typing your name on this form it is the same as your signature.Signature of Resident/Owner: *Date: *Comment:This form will be submitted to Merrie Holcomb, County Receptionist.Submit