OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES APPLICATION FOR TRANSFER DISABLED VETERAN OR FORMER PRISONER OF WAR OHIO LICENSE PLATES TYPE OR PRINT REGISTRATION INFORMATION FOUND ON OHIO REGISTRATION CARD. OHIO LICENSE PLATE NUMBER VEHICLE INFORMATION FROM OHIO CERTIFICATE/MEMORANDUM TITLE. YEAR MAKE TYPE COLOR CERTIFICATION OF TITLE NUMBER SERIAL NUMBER OWNER INFORMATION OWNER NAME PHONE NUMBER ( OHIO ADDRESS SOCIAL SECURITY NUMBER ) CITY JOINT OWNER NAME STATE ZIP CODE OHIO COUNTY OF RESIDENCE FILL IN CITY NAME ONLY if you live inside corporation limits. FILL IN TOWNSHIP ONLY if you live outside corporation limits. INCORPORATED CITY TOWNSHIP 1. Is your license plate registration under suspension or revocation under Ohio Financial Responsibility Law? YES NO 2. Has the motor vehicle being registered been operated by the owner on public roads or highways prior to date of the application? YES NO *OLD VEHICLE DATA YEAR MAKE TYPE SERIAL NUMBER SOLD TO (LAST NAME) FIRST NAME ADDRESS CITY MI STATE ZIP CODE PROOF OF FINANCIAL RESPONSIBILITY I Affirm that the owners (or lessees of leased vehicle) now have insurance or other proof of financial responsibility (FR Proof) covering this vehicle and will not operate or permit the operation of any vehicle without FR Proof; All pervious registration fees due have been paid and this plate category is correct. I also affirm that the vehicle described above is not to be used for farm or commercial purposes unless registered as farm or commercial, as defined under Ohio Revised Code 4501.01 and 4503.04, that my statements are correct, that the vehicle is lawfully entitled to registration, and that I grant limited Power of Attorney to the Registrar and Deputy Registrar to renew the vehicle registration. SIGNATURE OF OWNER(S) DATE X IMPORTANT 1. The following items must be returned to the: Ohio Bureau of Motor Vehicles - Gratis Unit, P.O. Box 16521, Columbus, Ohio, 43216-6521 a. b. c. d. 2. Completed and signed Application for Transfer. Certificate of Title or Memorandum Title (original document – not a copy). Leased vehicles, the original Certificate of Title along with a copy of the signed Lease Agreement must be sent. Self-addressed, stamped envelope for return of your title document. Current registration card for old vehicle. Failure to follow instructions may delay the processing of your application. WARNING: Applicant giving false information is subject to prosecution – R.C. 2913.42. Application must be signed by the owner(s) as named on certificate of title. Contact this office at (614) 752-7518 for more information or go to www.ohiobmv.com BMV 4506 9/08 American LegalNet, Inc. www.FormsWorkflow.com