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REQUEST FOR A DUPLICATE REGISTRATION CERTIFICATE

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Secretary of State Bureau of Motor Vehicles 29 State House Station Augusta, maine 04333 (207) 624-9000 Ext. 52149 REQUEST FOR A DUPLICATE REGISTRATION CERTIFICATE Fee $ Name ________________________________________ _____ Address ________________________________________ _______ City/State/Zip ________________________________________ __ Vehicle Year ____________________ Vehicle Make ___________________ Plate No. _______________________ 1. Is your REGISTRATION or privilege to register now under suspension? YES ______ NO ______ 2. Are you required to file an SR-22 CERTIFICATE of insurance with the Bureau of Motor Vehicles? YES ______ NO ______ I hereby REQUEST a DUPLICATE REGISTRATION for the vehicle described above in the information provided is true.

Secretary of State Bureau of Motor Vehicles 29 State House Station Augusta, Maine 04333 (207) 624-9000 Ext. 52149 REQUEST FOR A DUPLICATE REGISTRATION CERTIFICATE

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