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