New Plate No. Issued Year
New Year Validation Sticker No. Issued Year
Central Office Use Only
APPLICATION FOR DUPLICATE PLATES AND/OR STICKERS
MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICES DIVISION
445 Minnesota Street, Suite 160, St. Paul, MN 55101-5160
mndriveinfo.org
NOTICE
PLEASE READ INSTRUCTIONS BELOW BEFORE COMPLETING
A Duplicate Title IS NOT required when applying for duplicate plates or stickers.
New Weight Sticker No. Issued
VEHICLE IDENTIFICATION NUMBER
CURRENT PLATE NUMBER PLATE YEAR
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
MODEL YEAR MAKE TYPE
CURRENT
EXPIRATION DATE
MO. YR.
PRINT NAME OF OWNER(S)
(LAST, FIRST, AND MIDDLE)
DRIVER’S LICENSE NO.
PRINT ADDRESS OF
FIRST OWNER
(PERMANENT ADDRESS)
STREET CITY COUNTY STATE ZIP
FEES DUE
$
DUPLICATE
¢
SERVICE
THIS APPLICATION IS FOR A DUPLICATE: BOX ; PLATES YEAR STICKER WEIGHT STICKERS
THE REGISTRATION PLATES, YEAR STICKERS, AND/OR MONTH STICKERS
FOR THIS VEHICLE MUST BE REPLACED BECAUSE THEY WERE
; BOX I AM REPLACING THE
STICKERS FOR THE
STOLEN
LOST DEFECTIVE MONTH OF
DESTROYED
SURRENDERED NEVER RECEIVED YEAR OF
ISSUED IN ERROR
$
TOTAL
¢
MUST BE ANSWERED WHEN APPLYING FOR DUPLICATE PLATES
NAME OF INSURANCE COMPANY
POLICY NUMBER
I (WE), HAVING BEEN DULY SWORN, DO CERTIFY ALL OF MY (OUR)
DECLARATION ARE TRUE AND CORRECT AND THIS VEHICLE IS AND
WILL CONTINUE TO BE INSURED WHILE BEING OPERATED UPON
THE PUBLIC STREETS AND HIGHWAYS.
X
DATE:
OWNER’S SIGNATURE
IF PLATES AND/OR STICKERS
MUST BE SENT TO A TEMPORARY
ADDRESS, PRINT ADDRESS HERE
STREET CITY COUNTY STATE ZIP
INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING
1. Complete the application on this side only. PLEASE PRINT OR TYPE.
2. Attach this vehicle’s current registration card.
LOST
I cannot attach the current registration card because: It Was
DESTROYED
NEVER RECEIVED
I am currently driving outside the state of Minnesota and
must retain the registration card for proof of registration.
3. “Never Received” applies ONLY to plates and/or stickers mailed by the Driver and Vehicle Services Division.
Answer: In an attempt to find my plates and/or stickers I have contacted the Postal Service: Yes
No
If yes, when did you contact the Postal Service? 20
4. “Surrendered” applies ONLY to plates and/or stickers which were surrendered due to lack of insurance coverage.
5. To determine the fees due or to obtain assistance in completing this application, contact:
A DEPUTY REGISTRAR OR THE DEPARTMENT OF PUBLIC SAFETY, DRIVER AND VEHICLE SERVCIES DIVISION
MAKE REMITTANCE PAYABLE TO
: THE DRIVER AND VEHICLE SERVICES DIVISION
IMPORTANT NOTICE: PLEASE READ
The month and/or year stickers you are replacing MUST match the stickers originally on this vehicle. This application for duplicate plates and/or stickers must be completed by the
person(s) in whose name(s) this vehicle is now registered, and the registration card and any remaining plates and/or stickers must be surrendered to the registrar for cancellation.
If the lost plates and/or stickers are found, the customer is responsible for the proper disposal of these items.
All data collected on a motor vehicle application are required by law. These data are used to identify your motor vehicle. Failure to provide required data may result in denial of the
transfer of ownership, registration of this vehicle, or other requested action. Except for certain uses permitted by federal and state laws, personal information contained in your application
may not be disclosed to anyone without your express consent.
PS2067B-14
PRORATE CUSTOMERS ONLY:
Prorate Cab Card Must be Surrendered
Unit #
ccount #
