Seminole Lakes  Barcode Application
(One Barcode per Application)
 

Seminole Lakes                                                                     POA Barcode # : _________________
C/O Star Hospitality Management                                       Entered By: ______________________
26530 Mallard Way                                                              Date: ___________________________
Punta Gorda, Fl 33950                                                          Barcode Disabled Date:_____________
Phone: 941-575-6764                                                           Reason Disabled:__________________
Fax: 941-575-7968                                                               Disabled By: _____________________
E-Mail: star@sunletter.com

OWNER, Please Complete the Entire Form
Owner Information

PLEASE PRINT
Barcode Applicant:__________________________________________Owner [ ] Tenant [ ] Renter [ ]

Seminole Lakes Address: ____________________________________________________________

Alternate Address:__________________________________________________________________

If renter, give dates from approved rental agreement: _______________________________________

Vehicle Make/Model: ___________________________________Tag/State:____________________

Color:_______________________________________Year:________________________________

If vehicle is sold or no longer in your possession, please notify the POA to disable the barcode.
 

Owner: ________________________________________Local Phone Number:__________________

Address vehicle is registered to: ________________________________________________________

Out of State Phone:______________________________Cell Phone:___________________________

SIGNATURE OF APPLICANT_____________________________________________________DATE____________________