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APPLICATION AND AFFIDAVIT FOR HISTORICAL LICENSE …

BMV 4806 4/15 [760-1512] Page 1 of 2 RESTRICTED OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES APPLICATION AND AFFIDAVIT FOR HISTORICAL LICENSE PLATES DEFINITION, INSTRUCTIONS AND FEES ON BACK TYPE OR PRINT OHIO LICENSE plate # EXPIRATION DATE CERTIFICATE OF TITLE NUMBER INSPECTED BY DEPUTY NAME / DEPUTY # VEHICLE INFORMATION FROM OHIO CERTIFICATE / MEMORANDUM TITLE DATE PURCHASED YEAR MAKE MODEL SERIAL # CERTIFICATE OF TITLE # VEHICLE COLOR OWNER INFORMATION NAME DAYTIME PHONE # SSN / TIN / OH DL / OH ID OHIO ADDRESS CITY STATE OHIO ZIP CODE VEHICLE OWNERSHIP Single Joint Leased Company JOINT OWNER / LESSEE NAME SSN # OHIO COUNTY OF RESIDENCE OWNER BUSINESS ADDRESS CITY STATE ZIP CODE IS YOUR LICENSE plate REGISTRATION UNDER SUSPENSION OR REVOCATION UNDER OHIO FINANCIAL RESPONSIBILITY LAW?

bmv 4806 4/15 [760-1512] page 1 of 2 restricted ohio department of public safety bureau of motor vehicles application and affidavit for historical license plates

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