Fillable LOST, STOLEN, MUTILATED OR SURRENDERED LICENSE PLATE AFFIDAVIT (Department of Motor Vehicles )

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LOST, STOLEN, MUTILATED OR SURRENDERED LICENSE PLATE AFFIDAVIT (Department of Motor Vehicles )

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555 WRIGHT WAY
CARSON CITY, NV 89711
Reno/Sparks/Carson
City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
TDD (Hearing Impaired Only): (775) 684-4904
VP-202 (8/17)
LOST, STOLEN, MUTILATED OR SURRENDERED
LICENSE PLATE AFFIDAVIT
NRS 482.285
Please Print or Type
State of Nevada, County of _______________________________________ Date ___________________
Registered Owner’s Name___________________________________________________________________
Last First M.I.
Nevada Driver’s License, Identification Number, Date of Birth, or FEIN for a business_____________________
________________________________________________________________________________________
Physical Address City State Zip
________________________________________________________________________________________
Mai
ling Address City State Zip
I, _________________________________ do hereby certify under penalty of NRS 482.555, that my Nevada
License Plate(s) Number _______________
,
has been:
Lost Mutilated Stolen___________________________
Case Number (Required)
Note: Stolen license plates may not
be duplicated
Destroyed Illegible Left on Sold Vehicle
Confiscated/Surrendered____________________________________________________
Reas
on for confiscation and location turned into, such as State, DMV location, Authority
State of Nevada, County of _____________________
Signed and sworn to before me on
______________
Date
By ________________________________ Notary Stamp
Signature of Registered Owner
_____________________________________________
Notary Public or Authorized Nevada DMV Representative
PLEASE NOTE: It is recommended to report any lost or stolen license plates to your local law
enforcement agency in the event your license plates are used in an unlawful manner.
YOU MUST VISIT YOUR LOCAL FULL SERVICE DMV OFFICE TO OBTAIN A NEW SET OF PLATES
Signatures must be originals. Photocopies are not acceptable.
Changes may not be made to this form once it is signed and witnessed
.
Submitted by law enforcement on behalf of the registered owner:
Nam
e __________________________ Agency __________________________ Badge # __________
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LOST, STOLEN, MUTILATED OR SURRENDERED LICENSE PLATE AFFIDAVIT (Department of Motor Vehicles )

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Completed 24 December 2020

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