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REQUEST FOR A DUPLICATE REGISTRATION CERTIFICATE

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. _____ Signature Date MV-11 (1/2013)

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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