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AFFIDAVIT <br /> NON-RECEIPT OF MAIL <br /> License Plate Number: <br /> Vehicle Identification Number: <br /> Make: Type: <br /> I certify that I have not received the certificate/emblem/plate as indicated below which was mailed to <br /> my address of record. The address of record is my correct mailing address. I understand that upon <br /> issuance of a replacement, the original will no longer be valid for any purpose. If the original is <br /> subsequently delivered, I will return it together with the envelope that contained the item(s) mailed. <br /> CERTIFICATE OF TITLE CERTIFICATE OF REGISTRATION <br /> EMBLEM LICENSE PLATE <br /> Printed Name of Registered Owner Or Lienholder/Legal Owner Signature of Registered Owner <br /> of record for Duplicate Title Or Lienholder/Legal Owner of record for Duplicate Title <br /> Printed Name of Co-owner of record for Duplicate Title Signature of Co-owner of record for Duplicate Title <br /> Address <br /> City, State,Zip Code Date <br /> (FOR DEPARTMENT USE ONLY) <br /> TCL DATE ORIGINAL MAILED: <br /> NEW LICENSE PLATE NO.: NEW EMBLEM NO.: <br /> CLERK'S NAME: DATE PROCESSED: <br /> SUPERVISOR'S APPROVAL: <br /> Master Affidavit Non-Receipt of Mail.xls Hawai'i County is an Equal Opportunity Provider and Employer Created/Updated 7/29/2009 <br />