HomeMy WebLinkAboutApplication for Registration of Motor Vehicle COUNTY OF HAWAII
DEPARTMENT OF FINANCE
VEHICLE REGISTRATION&LICENSING DIVISION
101 PAUAHI STREET,SUITE#5
HILO,HAWAII 9672(
APPLICATION FOR REGISTRATION OF MOTOR VEHICLE
TYPEWRITE OR PRINT IN INK REGISTRATION EXPIRES
Make: Model: Body Type:
ElAir Cond. Trans. El AutF-j Man
Motive Power: 0Sas ❑DieselDButane El Propane Electric OFFICE USE ONLY
VIN# County Tax
Weight: Lbs. GVW Lbs. Year Model: State Tax
COLOR TOP OR FRONT I COLOR BOTTOM OR REAR Date Sold New:
State Registration
Vehicle Inspection Expires.
Odometer Reading: (No Tenths) Beautification
vTHE MILEAGE READING REFLECTS THE AMOUNT OF TITLE NUMBER Total Tax
MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS.
❑2.THE ODOMETER READING IS NOT THE ACTUAL Plate and/or Emblem
MILEAGE.WARNING:ODOMETER DISCREPANCY.
OFFICE USE ONLY County Fee
Present Lic.No. State:
ACCEPTED: PENALTY
TITLE REG. CAI B/S MSO County
B/L PERMIT# State
HOLD FOR: Total Penalty
TITLE REG. CAI B/S MSO Transfer Fee
DATE ISSUED: CLERK: Total
Hawari County Is an Equal Opportunity Provider and Employer
TYPEWRITE OR PRINT IN INK
REGISTERED OWNER(S):
Name
LAST FIRST MI
LAST FIRST MI
Mailing Address
STREET OR P.O.BOX ADDRESS
CITY STATE ZIP CODE
LIENHOLDER(IF NONE,WRITE"Ni
Name
Mailing Address
STREET OR P.O.BOX ADDRESS
CITY STATE ZIP CODE
I(we)hereby certify that I am(we are)the owner(s)to the extent indicated hereon of the motor vehicle described by this
application and that the foregoing statement is true to the best of my(our)knowledge and belief.
IF FIRM,PRINT NAME AND TITLE OF AUTHORIZED PERSON
X
SIGNATURE(S)OF REGISTERED OWNER(S)SHOWN ABOVE OR IF FIRM,AUTHORIZED PERSON
To be filled in by Branch of Service
members of U.S. ►
military forces. Station
If vehicle This application certified true and correct.
purchased new ► Name of Dealer
locally,dealer By
countersign here. AUTHORIZED SIGNATURE