OHIO BUREAU OF MOTOR VEHICLES REPLACEMENT PLATE/VALIDATION STICKER AND DUPLICATE REGISTRATION APPLICATION NAME LICENSE PLATE NO. ADDRESS VALIDATION NO. CITY ZIP CODE VEH. PURCHASE DATE VEH, YEAR ODOMETER READING VEH, MAKE VEH. TYPE VEH. SERIAL NO. INDICATE ONE (X) 1 PLATE ( FRONT REAR) 2 PLATE VALIDATION STICKER ONLY DUPLICATE REGISTRATION CARD TITLE NO. WERE PLATES LOST STOLEN DAMAGED? (If stolen, a copy of the police report must be submitted with each application) MAIL TO: OHIO BUREAU OF MOTOR VEHICLES Attention: GRATIS UNIT P.O. BOX 16521 Columbus, Ohio 43216-6521 Is your license plate registration under suspension or revocation by the Registrar under Ohio Safety Responsibility Law? YES NO X SIGNATURE DATE TELEPHONE NO. ( ) THIS APPLICATION NEED NOT TO BE NOTARIZED; HOWEVER APPLICANT GIVING FALSE INFORMATION IS SUBJECT TO PROSECUTION UNDER ORC 2921.13 BMV 4527 10/01 American LegalNet, Inc. www.FormsWorkflow.com