Corrected or Replacement Registration - Vermont …

1 Corrected or Replacement Registration DEPARTMENT OF MOTOR VEHICLES Agency of Transportation This application Car/Truck ATV Boat ATV = $ is for my Trailer Snowmobile Other Boat = $ Needs Correction Was Stolen Other Snowmobile = $ My Registration Was Destroyed Was Lost All Other = $ I need a Registration Certificate Sticker/Decal For Plate or Registration #. Name: Last First Middle Mailing Address (Address Where You Get Your Mail): If PO or Private Box, also fill in Physical Address below. City: State: Zip: Physical Address (Address Where You Live) NO PO or Private Box.

2 City: State: Zip: Above is a change to Mailing address Physical address Make Model Model Year Body Type Color Mileage (No Tenths). Serial Number (VIN) Vermont License or Permit #. If you have leased vehicles and your name or address has changed you MUST check the box & list plate numbers issued to each leased vehicle. If the address given differs from what appears on our records, this will be considered a notification of change of address for all your records. You are required to notify DMV within 30 days of any change in your mailing address, legal name or physical residence.

3 Name changes must be processed in person. Individual name change requires an original or certified copy of a marriage license/certificate or court order clearly stating the new name. Company name change requires a change of name certification from the office of Secretary of State. I hereby affirm, under penalty of perjury, that the information on this form is true to the best of my knowledge. This declaration made under penalties of 23 VSA 202 & 4110. Signature of Applicant: Date: Phone Number: Email Address: DMV USE ONLY. Plate/Reg # 490 CODE: C P NNR Car/Trk/Trl (06).

4 Name Change (231). Expires: Snow (36). Mail Address (232). Reg Type: Physical Address (233) Boat (37). Add Change Rater # 452 454. TOTAL $. VD-040 10/2017 MTC.