Form INIRP-L State Form 51290 (R1/07-04) Indiana Department of Revenue International Registration Plan Affidavit for Replacement Apportion (I.R.P.) License Plate or License Plate Transfer and Cab Card Destruction Notice Schedule L Registrant Name: Account Number: Street Address: City: State: Zip Code: Replacment plate transactions: list the VIN, make, year and missing license plate number(s) for the vehicle(s) in the area provided below. Indicate whether the license plate was lost, stolen, or mutilated and the status of the cab card. License plate transfer transactions: list the VIN and indicate whether the original cab card was destroyed. Original cab cards must be destroyed or returned to the IRP office. Vehicle Identification Number (VIN) Vehicle Make Vehicle Year Original License Plate Number Lost, Stolen, or Mutilated Did you destroy the original cab card? (if not, attach original cab card to this form) It is the responsibility of the carrier to file a police report to the appropriate law enforcement agency regarding the stolen or lost license plates. The listed license plates are only considered contraband after you file a police report and official records will show the original plate as invalid. You must submit the original cab card to the IRP Office or destroy it. The carrier swears or affirms under penalty of perjury that the statements herein are correct. Authorized Signature: Printed Name and Position: Telephone Number: Date: American LegalNet, Inc. www.FormsWorkflow.com