VSA 71 (02/25/2017)
Correct error in
Vehicle Identification Number (VIN):
CURRENT VIN
CORRECT VIN
VEHICLE INFORMATION CHANGE
BUSINESS INFORMATION CHANGE
Change Federal Employer Identification Number (FEIN) (a Copy of IRS assignment of FEIN is required)
Change Business Name (This represents a change of name only and not a change of ownership. Copy of IRS assignment of FEIN or copy of business
license with new name is required)
CORRECT BUSINESS NAMECURRENT BUSINESS NAME
CERTIFICATION
I certify and affirm that all information presented in this form is true and correct, that any documents I/we have presented to DMV are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that
knowingly making a false statement or representation on this form is a criminal violation.
DATE (mm/dd/yyyy)
OWNER/CO-OWNER SIGNATURE
Change Business Address (This represents a change of address only for the business. A letter documenting the old address, new address, and federal tax
identification number is required)
Current Business Address Correct Business Address
STREET ADDRESS STREET ADDRESS
CITY CITY
STATE ZIP CODE STATE ZIP CODE
CORRECT FEINCURRENT FEIN
Are any of the vehicle owners on active military duty or service?
OWNER FULL LEGAL NAME (last, first, middle, suffix) CO-OWNER FULL LEGAL NAME (last, first, middle, suffix)
TITLE NUMBER VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE PLATE NUMBER YEAR MAKE MODEL
LOCATION WHERE VEHICLE IS GARAGED (city/town)
CITY
COUNTY
NO
YES
REGISTRATION INFORMATION
Purpose: Use this form to change information on an existing vehicle record.
Instructions: Submit the completed form to any DMV Customer Service Center.
REGISTRATION-VIN-BUSINESS CHANGE
APPLICATION
