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TREASURY DIVISION OFFICIAL USE ONLY <br /> COUNTY OF HAWAII <br /> 101 PAUAHI STREET,SUITE 5 <br /> HILO,HAWAII 96720-4224 <br /> • WEM icetbn adept a u Irate Iseu <br /> Date-Clerk <br /> TYPEWRITE OR PRINT IN INK-Improperly filled application will not be accepted. <br /> License Plate Number. Registration Expiration -FEE <br /> Make: Emblem Number. $W 0 <br /> a <br /> Vehicle IdentificationNumber. <br /> Registered Owner of Record: <br /> Address: <br /> NUMBER AND STREET CITY ZIP CODE <br /> The undersigned certifies that the Certificate of Registration for the above described vehicle has <br /> been F-1 lost F]stolen F]mutilated F1 defaced, and hereby requests the issuance of <br /> duplicate,which issuance shall void the original certificate. <br /> DEFACED OR <br /> MUTILATED <br /> CERTIFICATE MUST SIGNATURE OF REGISTEREDOWNER OF RECORD <br /> BE SURRENDERED <br /> WITH THIS <br /> APPLICATION IF FIRM,PRINT NAME AND TITLE OF PERSON SIGNING <br /> .. . ........ .., Harm Carty Is an EQuel Oppaurtty Pmwkiw vW Empbyer ow-1101d <br />