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AFFIDAVIT FOR REGISTRATION

BMV 5712 11/15 [760-1512] Page 1 of 2 RESTRICTED OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES AFFIDAVIT FOR REGISTRATION STATE OF OHIO, COUNTY OF: SSN / DL# / ID# / TAX ID# DATE LAST NAME FIRST NAME MI ADDRESS CITY STATE ZIP CODE E-MAIL (Mail-In Only) I certify that I am in possession of the following described motor vehicle: YEAR MAKE BODY TYPE MODEL VIN REGISTRATION AS NON-COMMERCIAL MOTOR VEHICLE PICK-UP VAN: Any motor vehicle, including a farm truck as defined in the Ohio Revised Code ( ) , designed by the manufacturer to carry a load of no more than three quarters of one ton, and used exclusively for purposes other than engaging in business for profit.

BMV 5712 7/18 [760-1512] Page 2 of 2 RESTRICTED REGISTRATION AS A BUS The above described vehicle has a single rear axle and an enclosed body, with permanently installed and attached

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