APPLICATION FOR VEHICLE REGISTRATION REFUND Purpose: FMS 210 (09/10/2007) Use this form to request a refund of the DMV registration fee when vehicle tags are returned to DMV before expiration and have at least 6 months remaining on the registration NOTE: Your refund will be mailed to you. Ask the DMV representative to verify that your address is correct. Portions of your registration fee are not refundable. Read the Registration Refund Information below before completing this form. Save a copy of this form and contact your local county/city/town for complete information about your eligibility for refunds of local license fees. VEHICLE INFORMATION PLATE NUMBER TITLE NUMBER MAKE YEAR EXPIRATION DATE (mm/dd/yyyy) APPLICANT INFORMATION NAME EIN/DRIVER LICENSE NUMBER OR SOCIAL SECURITY NUMBER MAILING ADDRESS STATE CITY ZIP CODE CERTIFICATION I certify that this vehicle has been sold, disposed of, and/or will not be used on the roads and highways of Virginia without proper registration. OWNER SIGNATURE DATE (mm/dd/yyyy) CO-OWNER SIGNATURE DATE (mm/dd/yyyy) CHECK ONE AND SIGN BELOW (if applicable) EXECUTOR ADMINISTRATOR OF ESTATE LEGAL HEIR POWER OF ATTORNEY OWNER SIGNATURE DATE (mm/dd/yyyy) REGISTRATION REFUND INFORMATION Your refund check should be received within 30 days from the date of your application. If not, you may call (804) 367-0155 or write to: DMV Refund Section, Financial Management Services, P. O. Box 25700, Richmond, Virginia 23260. Refund amounts are based on each 6 full months remaining in the registration period. No refunds are made if less than 6 full months remain in the registration period. The following portions of the registration fee are not DMV fees and are not refundable: the State Inspection Fee, Emergency Medical Services Fee and, any applicable Emissions Fee. Special plate fees which are charged only one time, rather than annually, are not refundable. A $5 processing fee is charged if none of the registration period has passed. American LegalNet, Inc. www.FormsWorkFlow.com