OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES NO FEE GRATIS REGISTRATION APPLICATION PUBLIC OWNED VEHICLE BMV USE ONLY MO. DAY LICENSE # YR. VEH. PURCHASE DATE CERTIFICATE OF TITLE # VEHICLE DATA YEAR MO. MAKE TYPE COLOR YR. WILL THE VEHICLE DESCRIBED HEREIN BE USED EXCLUSIVELY FOR GOVERNMENTAL OR PROPRIETARY FUNCTIONS? YES NO TRAILER OWNER TRUCK/CARGO VAN GOVERNMENT CLASS FEDERAL STATE NAME MOTORCYCLE CUSTOMER # INDICATE TYPE OF VEHICLE BY X PASSENGER CAR/VAN SERIAL NO. COUNTY CITY VILLAGE ADDITIONAL NAME TOWNSHIP OTHER BUS ADDRESS CITY STATE ZIP CODE MAILING ADDRESS (if different) BUSINESS PHONE ( MAIL TO: OHIO BUREAU OF MOTOR VEHICLES ATTN: GRATIS UNIT P.O. Box 16521 Columbus, Ohio 43216-6521 ) IMPORTANT 1. APPLICATION MUST BE FULLY COMPLETED AND SIGNED. 2. ORIGINAL CERTIFICATE OF TITLE FOR THE NEW VEHICLE MUST ACCOMPANY APPLICATION SIGNATURE OF CONTACT PERSON X TELEPHONE NUMBER DATE WARNING—APPLICANT GIVING FALSE INFORMATION IS SUBJECT TO PROSECUTION—OHIO REVISED CODE 2913.42. APPLICATION MUST BE SIGNED BY OWNER(S) AS NAMED ON CERTIFICATE OF TITLE. BMV 4511 9/08 American LegalNet, Inc. www.FormsWorkflow.com