THIS APPLICATION IS FOR DUPLICATE (Please check all that apply):
The registration plates, year stickers and/or month stickers for this
vehicle must be replaced because they were (check all that apply):
INSTRUCTIONS: Please Read Carefully Before Completing Form
1. Complete this application on this side only. PLEASE PRINT OR TYPE.
2. Attach this vehicle's current registration card.
PS2067B-16 (01/16)
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street Saint Paul, MN 55101-5160
Phone: (651) 297-2126 TTY: (651) 282-6555 Web: dvs.dps.mn.gov
APPLICATION FOR DUPLICATE PLATES AND/OR STICKERS
PLEASE READ INSTRUCTIONS BELOW BEFORE COMPLETING
A Duplicate Title is NOT required when applying for duplicate plates or stickers
PLATES
DESTROYED
LOST
SURRENDERED
VEHICLE IDENTIFICATION NUMBER
MAKE
MODEL YEAR
DRIVER'S LICENSE NUMBERLAST, FIRST AND MIDDLE NAME
PRINT NAME OF OWNER(S)
u
u
FEES DUE
PRINT ADDRESS OF
FIRST OWNER
(PERMANENT ADDRESS)
ZIP CODESTATECITYSTREET ADDRESS COUNTY
ZIP CODESTATECITYSTREET ADDRESS
STOLEN
DUPLICATE
FILING
TOTAL
CENTRAL OFFICE USE ONLY
YEARMONTH
CURRENT
EXPIRATION DATE
/
TYPE
New Plate Number Issued YEAR
New Year Validation Sticker No. Issued YEAR
New Weight Sticker No. Issued
CENTRAL OFFICE USE ONLY
CURRENT PLATE NUMBER
YEAR STICKERWEIGHT STICKERS
ISSUED IN ERROR
DEFECTIVE
NEVER RECEIVED
YEAR of:
MONTH of:
I am replacing the
stickers for the
OWNER'S SIGNATURE
X
If plates and/or stickers must be sent to a temporary address, print address here:
I (WE), HAVING BEEN DULY SWORN, DO CERTIFY ALL OF MY (OUR) DECLARATION ARE TRUE AND CORRECT AND THIS VEHICLE IS AND WILL CONTINUE TO BE
INSURED WHILE BEING OPERATED UPON THE PUBLIC STREETS AND HIGHWAYS.
DATE
NEVER RECEIVED
DESTROYED
LOST
I am currently driving outside the state of Minnesota and
must retain the registration card for proof of registration.
3. “Never Received” applies ONLY to plates and/or stickers mailed by the Driver and Vehicle Services Division.
4. “Surrendered” applies ONLY to plates and/or stickers which were surrendered due to lack of insurance coverage.
5. To determine the fees due or to obtain assistance in completing this application, contact:
No
Yes
In an attempt to find my plates and/or stickers I have contacted the Postal Service?
If yes, when did you contact the Postal Service?
20
A deputy registrar or the Department of Public Safety, Driver and Vehicle Services Division
Make remittance payable to: The Driver and Vehicle Services Division
IMPORTANT NOTICE: PLEASE READ
The month and/or year stickers you are replacing MUST match the stickers originally on this vehicle. This application for duplicate plates and/or stickers must be completed
by the person(s) in whose name(s) this vehicle is now registered, and the registration card and any remaining plates and/or stickers must be surrendered to the registrar for
cancellation.
All data collected on a motor vehicle application are required by law. These data are used to identify your motor vehicle. Failure to provide required data may result in denial
of the transfer of ownership, registration of this vehicle or other requested action. Except for certain uses permitted by federal and state laws, personal information contained
in your application may not be disclosed to anyone without your express consent.
I cannot attach the current registration card because it was:
PRORATE CUSTOMERS ONLY:
Prorate Cab Card Must be Surrendered
UNIT #:
ACCOUNT #:
