New York State Department of Motor Vehicles AFFIRMATION FOR RENEWAL/LOST REGISTRATION FOR ABSENTEE OWNER I affirm that I am the __________________________ of _______________________________________________ , (Relation to Registrant) (Name of Registrant) who is the registrant of the vehicle bearing New York State Plate number ___________________________________. / / The registration is expiring _________________________. The registrant is in the military service of the United States of America and has given me permission to use the above-mentioned vehicle during his/her absence. The registrant cannot be reached to sign the renewal application. Complete statement below if it applies to this vehicle. license plate certificate of registration for the vehicle has been lost, and the registrant The cannot be reached to sign the statement reporting such loss. (Print Name in Full) ± (Signature - Sign Name in Full) IMPORTANT: FALSE STATEMENTS ARE PUNISHABLE UNDER SECTION 210.45 OF THE PENAL LAW MV-454 (10/07) www.nysdmv.com American LegalNet, Inc. www.FormsWorkFlow.com