Vehicle Plate Registration

Vehicle Plate Registration

Parties and Recitals

Registrant Name:

Registrar Name (Issuing Authority or Authorized Agent):

WHEREAS, Registrant is the legal owner or authorized representative of the motor vehicle described below and seeks issuance or transfer of vehicle registration plates; and

WHEREAS, Registrar is authorized to accept applications, collect applicable fees, and issue registration plates under the applicable statutes and administrative rules; and

WHEREAS, the parties enter this registration record to set forth the information, fees, certification and conditions governing issuance, renewal, transfer and cancellation of vehicle plates.

Registrant Information

Vehicle Details

Vehicle Identification Number (VIN):

Year:    Make:    Model:

Body Type:    Color:    Odometer Reading:

Passenger vehicle    Commercial vehicle    Motorcycle    Trailer    Other

Scope of Registration Services

The Registrar shall: accept this application, verify ownership and required documentation, collect fees required by this record, and issue or transfer vehicle plates and registration credentials in accordance with the information supplied below and applicable law. The Registrar's issuance of plates is conditioned on receipt of all required fees, documentation and verifications.

Payment Terms

Registration Fee Amount:

Payment Schedule: . Fees are due upon submission of this application unless otherwise provided in writing.

Late Fee: If payment or renewal is not received by the due date, a late charge of will be assessed. The late fee is cumulative and payable in addition to any outstanding registration fees and costs of enforcement.

Term and Termination

Effective Date: . Registration shall remain in effect until Expiration Date: unless earlier suspended, revoked or terminated in accordance with this record or controlling law.

Notice Period for Termination or Cancellation: days' written notice is required for voluntary cancellation by the Registrant; Registrar may suspend or cancel registration immediately where required by law or when material falsehood, fraud or safety risk is established.

Confidentiality and Data Use

Registrant personal information contained in this application is collected and maintained for vehicle registration purposes. Registrar will protect personal data consistent with applicable privacy law. Registrar may disclose registration data to law enforcement, other governmental authorities, lienholders and as otherwise required by law or court order. Registrant hereby consents to necessary disclosures for the issuance, enforcement and administration of registration.

Certifications; Declarations

By signing below, Registrant certifies under penalty of perjury that all information provided on this form is true, correct and complete to the best of Registrant's knowledge, that Registrant is the legal owner or authorized agent of the vehicle described, and that Registrant will notify Registrar promptly of any change affecting registration status.

I certify:

Governing Law; Entire Agreement

This registration record shall be governed by and construed in accordance with the laws applicable to the jurisdiction of the Registrar. This document constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior communications and representations, whether oral or written. Any modification must be in writing and signed by both parties.

Acknowledgments and Administrative Use

Application received by:    Date received:

Plate Number Issued:    Registration Certificate No.:

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