Expired Registration
Has a citation been issued for expired registration on this vehicle?
Yes
No
Has this vehicle been driven by anyone since the registration expired?
Yes No
Plate #
Year/Make
I understand that, upon my signature, no penalty will be collected after this date.
Signature of Owner or Agent: Date:
MV-469A www.hctax.net Rev 8/18 v2
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Expired Registration
Has a citation been issued for expired registration on this vehicle?
Yes
No
Has this vehicle been driven by anyone since the registration expired?
Yes No
Plate #
Year/Make
I understand that, upon my signature, no penalty will be collected after this date.
Signature of Owner or Agent: Date:
MV-469A www.hctax.net Rev 8/18 v2
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