APPLICATION FOR DUPLICATE OR REPLACEMENT OF …

RrrrREASON:CHECK (4) PROPER BLOCKA pplication for DUPLICATE Registration Card(s) - Complete Sections A, B and either C or D. REPLACEMENT of Registration Plate or Weight Class Sticker - Complete Sections A, B and either C or D. NOTE: Section D must be completed for all REPLACEMENT registration plate requests and all products that were not received in the mail within 90 days of original issuance date. Section D is not required to be completed when applying for a REPLACEMENT weight class sticker that was lost or APPLICANT AND VEHICLE INFORMATION AS LISTED ON CURRENT REGISTRATION CARDAPPLICATION FOR DUPLICATE CAB CARD(S) OR REPLACEMENT OF PRODUCT - Check ( 4) appropriate Account NumberLast Name (or Full Business Name)Co-Owner Last NameSUBSCRIBED AND SWORN TO BEFORE ME: MONTH DAY YEARCityStateZip CodeFirst NameMiddle NameMiddle NameFirst NameEquipment NumberTitle NumberExpiration Date MO:YR:Owner s Change of Address rr rCab Card Registration Plate Weight Class Sticker - Class #: _____*NOTE: Cab Card: The fee for a REPLACEMENT registration card is $

APPLICATION FOR A REPLACEMENT APPORTIONED REGISTRATION PLATE - Complete only if replacement registration plate is requested or if applicant is entitled to free re-issuance because original registration card or weight class sticker was never received in the mail and application is being made within 90 days of original issuance or replacement. D Date

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  Applications, Original, Replacement, Or replacement

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