PLATE NUMBER MAKEMODEL YEAR
TODAY'S DATEREGISTERED OWNER(S) (LAST, FIRST, MIDDLE NAME)
STATECITYSTREET ADDRESS (LESSEE IF APPLICABLE) COUNTY
VEHICLE INFORMATION
STYLE
ZIP CODE
DATE OF BIRTH
2.
3.
1.
1.
2.
3.
If checked,
party is lessee.
party is lessee.
If checked,
If this vehicle is driven on Minnesota roads and highways prior to the completion of this process the vehicle owner or operator may be subject to
citation and/or vehicle impoundment by law enforcement.
PLATE NUMBER MAKEMODEL YEAR
TODAY'S DATEREGISTERED OWNER(S) (LAST, FIRST, MIDDLE NAME)
STATECITYSTREET ADDRESS (LESSEE IF APPLICABLE) COUNTY
VEHICLE INFORMATION
STYLE
ZIP CODE
DATE OF BIRTH
2.
3.
1.
1.
2.
3.
If checked,
party is lessee.
party is lessee.
If checked,
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street Saint Paul, MN 55101-5187
Phone: (651) 297-2126 TTY: (651) 282-6555 Web: dvs.dps.mn.gov
No VIN Attestation
DVS COPY
DEPUTY STAMP
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street Saint Paul, MN 55101-5187
Phone: (651) 297-2126 TTY: (651) 282-6555 Web: dvs.dps.mn.gov
No VIN Attestation
CUSTOMER COPY
DEPUTY STAMP
Please retain this document for your records
Rev. 02/2017
02/2017
This only applies to motorized vehicles and semi-trailers: Be aware that although you are paying for and possibly receiving license plates
and registration stickers, this vehicle MAY NOT be driven on Minnesota roads and highways until a Vehicle Identification Number (VIN)
has been assigned and an inspection of the vehicle has been completed by Minnesota Driver and Vehicle Services.
This only applies to motorized vehicles and semi-trailers: Be aware that although you are paying for and possibly receiving license plates
and registration stickers, this vehicle MAY NOT be driven on Minnesota roads and highways until a Vehicle Identification Number (VIN)
has been assigned and an inspection of the vehicle has been completed by Minnesota Driver and Vehicle Services.
Owner's Signature
If this vehicle is driven on Minnesota roads and highways prior to the completion of this process the vehicle owner or operator may be subject to
citation and/or vehicle impoundment by law enforcement.
