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REQUEST FOR REGISTRATION

If the above vehicle is leased, please list the Lessor s name in the space below. NoTE:If Form MV-1L has never been filed with penndot , theleasing company (Lessor) must complete Form MV-1L and return the completed form along with this NumberInsurance Company NamePolicy NumberPolicy Effective Policy ExpirationDateDateStreet AddressLessor NameEligible Applicant's NameEligible Applicant s Actual Income During the Past Calendar YearEligible Applicant's Date of BirthCityStateZip CodeRegistration Plate NumberBody TypeReg. Gross Wt. (if applicable)Last Name (or Full Business Name) First Name Middle Name Reg. Comb. Wt. (if applicable)No. of Axles - (Complete onlyif truck or truck tractor.)Expiration DateMake of VehicleVehicle Identification NumberI certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I am retired and receiving Social Security and/orother pension and income as listed in this section.

You may renew your registration via mail, however, you can enjoy the convenience of paying your registration fee. online from home or a mobile device, printing and signing a permanent registration credential, without waiting . for delivery by mail. PennDOT will no longer mail a registration card for registrations renewed online. 1.

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