HomeMy WebLinkAboutVRL-MVR554 Application for Plate or Emblem Replacement - FillableOFFICE USE ONLY
DATE CLERK
COUNTY OF HAWAII
DEPARTMENT OF FINANCE
VEHICLE REGISTRATION & LICENSING DIVISION
101 PAUAHI STREET SUITE NO. 5
HILO, HI 96720
Application for Replacement
OF LICENSE PLATE AND/OR DECAL
TYPEWRITE OR PRINT IN BLACK INK
OFFICE USE ONLY
LICENSE PLATE REPLACEMENT
OFFICE USE ONLY
EMBLEM REPLACEMENT
I HEREBY CERTIFY THAT THE PLATE AND/OR DECAL FOR THE VEHICLE BEARING:
License No.:
Make:
Emblem No.:
VIN No.:
Type:
Emblem Expiration:
HAS BEEN LOST MUTILATED STOLEN STORED DESTROYED
In accordance with Section 249-8, Hawaii Revised Statues as amended, I hereby make application for the
replacement of:
Plate and/or Emblem
The mutilated plates and/or remaining plate were return for cancellation: Back Front None
Check one if you are converting to passenger or commercial.
REGISTERED OWNER(S) OF RECORD:
Name:
LAST NAME, FIRST NAME, MI
Mailing Address:
STREET OR P.O. BOX ADDRESS CITY, STATE, ZIP CODE
_________________ X _____________________________________________________________________
DATE SIGNATURE OF REGISTERED OWNER
FEE: Emblem Only $0.50 Plate Only $5.00 Plate and Emblem $5.50
VRL-MVR 501
Rev. 05/22