MSP - Michigan Speed Measurement Task Force Replacement Certificate Request Form

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Michigan Speed Measurement Task Force Replacement Certificate Request Form

The purpose of this form is to allow Michigan Police Agencies to request a replacement radar/laser certificate. Please fill out all fields as fully as possible. This will help ensure that we have sufficient information to locate your original certificate. We can then send and/or fax a replacement certificate to you in a timely fashion. The radar/laser device must have a MSMTF ID number if a replacement certificate is requested online. For those devices without this ID nubmer, contact the manufacturer for a replacement certificate.

Please tell us the reason that you need a replacement certificate?

Original Certificate:

Other:

Tell us the following information about the unit that you are requesting a replacement certificate for:

Type of Speed Measurement Device



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MSMTF Tag Identification Number (e.g. ND-03-222)

[**FIELD MUST BE FILLED IN**]

Manufacturer of the Unit

Model of the Unit

Manufacturer Assigned Serial Number of the Counting Unit

Enter any additional comments in the space provided below:

Tell us how to get in touch with you:

Name    

Police Agency    

Street Address   

City   

State    

ZIP Code    

E-mail

Telephone Number

FAX Number

Do you need us to fax you a copy of the replacement certificate?

Please contact me as soon as possible regarding this matter by


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