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MV-34 (Revised 7-2017)
Web and MV Manual
Georgia Department of Revenue - Motor Vehicle Division
Electronic Title & Registration (ETR)
Change of Address Affidavit
Purpose of this Affidavit: This affidavit is to be used to record a change of address for an ETR transaction. Please note: This address change
affidavit must be submitted even if the vehicle purchase is cancelled.
Completing this Affidavit: Complete sections A, B and C (if applicable). Certify by signature and notarization that your address is correctly
printed or typed.
How to submit this Affidavit: An electronic image of this completed change of address affidavit must be submitted electronically to the
Department of Revenue within fifteen (15) days from the date of the change of address transaction.
A
PERSONAL INFORMATION
Full Legal Name:
First Name
Last Name
Suffix
Driver’s License/
ID Card No.:
License/ID Card
Expiration Date:
M
M
-
D
D
-
Y
Y
Y
Y
B
NEW or CORRECTED RESIDENTIAL ADDRESS (Please do not enter a P.O. Box address in this section.)
Street Address:
Street No.
Street Name
Apt No.
City:
State:
ZIP Code:
County:
C
NEW or CORRECTED MAILING ADDRESS (If different from the residence address.)
Street Address/
P.O. Box:
Street No.
Street Name or P.O. Box
Apt No.
City:
State:
ZIP Code:
County:
D
CERTIFICATION
I do solemnly swear or affirm under penalty of false statement, in accordance with the provisions of Georgia law, that the name, driver’s
license and address provided on this affidavit are true and accurate.
Signature:
Date:
E
ACKNOWLEDGEMENT OF NOTARY PUBLIC
Sworn to and subscribed before me this
day of
Month
,
Year
Notary Seal or Stamp
Notary Public’s
Full Legal Name:
Physical Address:
City:
State:
ZIP Code:
Email Address:
Telephone No.:
Signature of
Notary Public:
Commission Expires:
[t21: 11179810]
*COAA1705090848*
TAMI
L
ROSSANO
0 5 0 4 7 2 7 0 7
4119 McEver Woods Dr
Acworth
GA
30101
05/02/2020
PRINT
CLEAR
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