HomeMy WebLinkAboutVRL-MVR506 - JUNK Status ApplicationREV. 11/20
COUNTY OF HAWAII
DEPARTMENT OF FINANCE
VEHICLE REGISTRATION & LICENSING DIVISION
101 PAUAHI STREET SUITE NO. 5
HILO, HI 96720
APPLICATION FOR “JUNK” STATUS
The undersigned owner(s) of the vehicle described as indicated in the records of the Director of Finance, County of Hawaii,
State of Hawaii:
Registered Owner(s):
LAST NAME, FIRST NAME, MI
License No.: Type: Make:
VIN No.: Registration expiration:
Hereby certifies that said vehicle is incapable of safe operation for use on the public highway and has no resale value
except as a source of parts or scrap only.
This vehicle is junked under HRS §51.5 and shall never again be titled or registered. Signing below confirms my decision to
junk this vehicle.
X ___________________________________________________ __________________
SIGNATURE OF REGISTERED OWNER DATE
X ___________________________________________________ __________________
SIGNATURE OF REGISTERED OWNER DATE
By signing below, I understand that I have the option to STORE my license plates instead of applying for “JUNK” status.
Signing below confirms my decision to DECLINE the storing of my license plates.
X ___________________________________________________ ___________________
SIGNATURE OF REGISTERED OWNER DATE
X ___________________________________________________ ___________________
SIGNATURE OF REGISTERED OWNER DATE
Accordingly, the last issued Certificate of Title which has been properly endorsed and both license plates are herewith
surrendered for cancellation.
X ___________________________________________________ ___________________
SIGNATURE OF REGISTERED OWNER DATE
X ___________________________________________________ ___________________
SIGNATURE OF REGISTERED OWNER DATE
FOR OFFICE USE ONLY:
LICENSE PLATES SURRENDERED? : FRONT BACK
IF NO: LOST DESTROYED STORED