VP 258 - Active Duty Military Combat Affidavit - …

1 555 Wright Way Carson City, NV 89711 Reno/Sparks/Carson City (775) 684-4 DMV (4368) Las Vegas area (702) 486-4 DMV (4368) Rural Nevada or Out of State (877) 368-7828 VP258 (8/2012) Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this for once it is signed and witnessed. Active duty Military Combat Affidavit 2011 Senate Bill 406 (NRS 482) The completed Active duty Military Combat Affidavit must be submitted at the time of the vehicle registration renewal to claim this exemption of all late fees.

2 The dates for your deployment must have occurred when your vehicle registration expired. Please type or print Vehicle Identification Number Year Make Model License Plate Full Legal Name First Middle Last Nevada Driver s License, Identification Card Number, or Date of Birth Physical Address Address City State Zip Code Mailing Address Address City State Zip Code Telephone E-mail I declare under penalty of perjury that the foregoing is true and correct. My position was Combat or Combat support from the beginning date of _____ until the ending date of _____.

3 Affiant s Printed Full Legal Name _____ State of Nevada, County of _____ Signed and sworn to before me on _____ By _____. Signature of Affiant _____ Notary Public or Authorized Nevada DMV Representative