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Mv 904sp 2015
Department Use Only
Bureau of Motor Vehicles • PO Box 68293 • Harrisburg, PA 17106-8293
Make of Vehicle
Date of Birth
Telephone
Home (
Office (
State
City
Year
) _______________
) _______________
Zip Code
nOtE: In conjunction with replacement of your plate, you will receive one registration card. If additional registration cards are desired, the fee is $2
for each card. number of Duplicate registration cards requested @ $2 each _________.
tO BE cOMplEtED BY OrgAniZAtiOn...
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