MISSING PERMIT / RFID TAG REPORT
INCIDENT REPORT #
REPLACEMENT PERMIT #
LOCATION OF INCIDENT
DATE / TIME REPORTED
UTEP ID NUMBER
NAME OF COMPLAINANT
ADDRESS
PHONE # (Home / Work)
MISSING DECAL INFORMATION
Type of Permit
Hangtag
AdhesiveCard
Missing Permit / RFID tag Number:
School Year:
VEHICLE INFORMATION
Make:
Model:
Year:
2 Door
Color:
License Plate #:
4 Door
Truck
Other
State:
AN ADMINSTRATIVE CHARGE WILL BE ASSESSED FOR ANY PERMIT/RFID TAG ISSUED TO REPLACE A MISSING
PERMIT THAT WAS ORIGINALLY ISSUED IN PERSON OR SHIPPED BY MAIL.
Narrative:
(Reason for Request: Describe how the permit/RFID tag became missing)
DISCLAIMER
I attest that the information given on this form is correct and accurate. I understand that I will be assessed an
administrative fee for any permit replacement. I also understand that any misuse of the missing permit may
subject any unauthorized driver and vehicle displaying the permit to be immobilized, to be issued a citation, and to
possible disciplinary action by the Dean of Students.
§37.08 False report to peace officer or law enforcement employee. (a) A person commits an offense if, with
intent to deceive, he knowingly makes a false statement that is material to a criminal investigation and makes the
statement to: (1) a peace officer conducting an investigation; or (2) any employee of a law enforcement agency
that is authorized by the agency to conduct the investigation and that the actor knows is conducting the
investigation. (b) In this section, “law enforcement agency” has the meaning assigned by Article 59.01, Code of
Criminal Procedure. (c) An offense under this section is a Class B misdemeanor ____________ (Please initial)
Complainant’s Signature
Date
PTS Representative’s Signature
Date