AFFIRMATION FOR RENEWAL/LOST
REGISTRATION FOR ABSENTEE OWNER
I affirm that I am the of ,
(Relation to Registrant) (Name of Registrant)
who is the registrant of the vehicle bearing New York State Plate number .
The registration is expiring .
The registrant is in the military service of the United States of America and has given me permission to use the
above-mentioned vehicle during his/her absence.
The registrant cannot be reached to sign the renewal application.
Complete statement below if it applies to this vehicle.
The license plate certificate of registration for the vehicle has been lost, and the registrant
cannot be reached to sign the statement reporting such loss.
(Print Name in Full)
X
(Signature - Sign Name in Full)
IMPORTANT: FALSE STATEMENTS ARE PUNISHABLE
UNDER SECTION 210.45 OF THE PENAL LAW
MV-454 (11/15)
dmv.ny.gov