HomeMy WebLinkAboutVRL-MVR500 - Application for Registration of Motor Vehicle 2024APPLICATION FOR REGISTRATION
PASSENGER NON-COMMERCIAL PROPERTY CARRYING
TYPEWRITE or PRINT IN INK
Make: Body Type: Air Condition
Motive Power: Gas Diesel Butane Propane Electric Hybrid Plug-in Hybrid
Vehicle I.D. No.:
Weight: Lbs. GVW: Lbs. Year Model:
COLOR TOP OR FRONT COLOR BOTTOM OR REAR Date Sold New:
HVUC 8,000 lbs. OR MORE HVUC 20,000 lbs. OR MOREBODY TYPE: DUMP, MSTR., TANK, TRTC., TCRN.BODY TYPE: STKE., TOWK., FTBD.
Odometer Reading: (NO TENTHS)
1.
2. The odometer reading is not the actual mileage.
WARNING: ODOMETER DISCREPANCY
OFFICE USE ONLY
Present Lic. Plate No.: County or State:
ACCEPTED:
TITLE REG CAI B/S MSO
B/L PERMIT NO.
HOLD FOR:
TITLE REG CAI B/S MSO
OTHER:
Vehicle Inspection Expires:
HOLD TITLE
Transmission: Automatic Manual
—
AUTHORIZED SIGNATURE
Station
By
LIENHOLDER (IF NONE, WRITE “NONE”):
Name:
Mailing Address:
TYPEWRITE or PRINT IN INKREGISTERED OWNER(S):
Name:
Mailing Address:
LAST FIRST M.I.
LAST FIRST M.I.
STREET OR P.O. BOX ADDRESS
CITY STATE ZIP CODE
LAST FIRST M.I.
STREET OR P.O. BOX ADDRESS
CITY STATE ZIP CODE
statement
IF FIRM, PRINT NAME AND TITLE OF AUTHORIZED PERSON
X X
locally, dealer countersign here.
VRL-MVR500 - REVISED: OCT 2024
SIGNATURE(S) OF REGISTERED OWNER(S) SHOWN ABOVE OR IF FIRM AUTHORIZED PERSON
REGISTRATION EXPIRES
OFFICE USE ONLY
County Tax
State Tax
State Registration
Total Tax
Plate and/or Emblem
County Fee
Alternative Fuel Fee
P E N A L T Y
Total Penalty
TOTAL $
County
State