Statement Of Military Absence
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Statement Of Military Absence Form. This is a Ohio form and can be use in Bureau Of Motor Vehicles Statewide.
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Tags: Statement Of Military Absence, BMV 5717, Ohio Statewide, Bureau Of Motor Vehicles
OHIO DEPARTMENT OF PUBLIC SAFETY
STATEMENT OF MILITARY ABSENCE
New License Number
Validation Sticker Number
Owner(s) Name (as appears on Ohio Title)
Ohio Address
Printed Application Number
License Number
City
State
Zip
SS.
STATE OF OHIO
COUNTY OF
Name (Affiant)
Agent’s Address
City
State
Zip
Certifies that:
Owner/Co-owner Name
Military Address
is the owner of the following described motor vehicle:
Make
Type
Vehicle Identification Number
Year
Certificate of Title Number
Relationship
And, that
he is
of said owner/co-owner who is in the military service of the United States and located
outside of the borders of the United States and the affiant further says that he has authority
to execute the application for registration on behalf of the owner and obtain license plates
for such motor vehicles. The affiant further states that the above described car is
encumbered by a lien. The lien holder is:
Name of Lien Holder
Address
If the affiant applies for the registration of the above described motor vehicle, and the
Registrar grants such application, the affiant agrees to surrender the registration card and
plates to the Registrar upon his request with or without cause, without a refund.
Affiant Signature
Date
DEPUTY: Send this statement with (NOT ATTACHED TO) original copy of Registration Application. If a
lien exists. “Lien Holders Consent” form must also accompany application.
BMV 5717 10/04
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