Massachusetts Registry of Motor Vehicles
P.O Box 55889
RMV-3 Form
1. � Renewal � Amendment
2. Current Registration # 3. Title # 4. Vehicle Identification Number (VIN)
� Other:________________
Boston, MA 02205-5889
O. ORANGE 3. BROWN 6. GREEN 9. PURPLE
1. BLACK 4. RED 7. WHITE
2. BLUE 5. YELLOW 8. GRAY
5. Model Year
7. Model Name
8. Model #
9. Circle Color(s) of Vehicle6. Make
10. Cyl/Pass/Doors/Wheels
11. Trans
Auto �
Manual �
12. City/Town Vehicle is Principally Garaged
13. Expiration Date Month / Year
14. Name of Owner(s)/Co/Corp/or Sole Proprietor
Owner #1: Owner #2:
15. Owner # 1 License # / ID # / or SSN ________________________________________ Date of Birth _______________________
EIN / FID# for Corp/Co/Org or Sole Proprietor (if Sole Proprietor, also provide SSN) _______________________________________________________
Owner # 2 License # / ID # / or SSN ________________________________________ Date of Birth _______________________
EIN / FID# for Corp/Co/Org or Sole Proprietor (if Sole Proprietor, also provide SSN) _______________________________________________________
23. If Vehicle Used For Transporting Goods, Wares, or
Merchandise
WT. of Vehicle Fully Equipped ________________
Max. Load or Heaviest Semi-Trailer With Load ________________
Total Gross Weight ________________
27. Policy Effective Date
Policy Change Date
24. If School Bus, is it Used Exclusively Under Contract to City /
Town / School District?
Yes _______ No ________
29. The company signatory hereto hereby certifies that it has or will insure or guarantee
performance by the applicant herein before named with respect to the motor vehicle hereinbefore
described for a period of at least coterminous with that of such registration under a motor vehicle
liability policy, binder, or bond which conforms to the provisions of general laws chapter 175,
section 113A and that the premium charge and classification of the effective date of registration
are as established by the commissioner of insurance under chapter 175, section 113B.
25. If Vehicle Carrying Passengers For Hire, Max. Number of
Passengers that can be Seated
___________________________________
Insurance Company
Agent
Insurance CO.’s Authorized Representative’s Signature/Date
30. I /We the applicant(s) hereby certify under the penalties of perjury that there are no
outstanding excise tax liabilities on the vehicle described above that have been incurred by
the applicant(s), any member of the applicant’s immediate family who is a member of the
applicant’s household, or the business partner of the applicant(s). ***The undersigned hereby
further certify that all information contained in this application is true and correct to the best of
their knowledge and belief. False statements are punishable by fine, imprisonment, or both.
Owner #1 Signature_______________________________________________________________________
Owner #2 Signature_______________________________________________________________________
19. If Leased Vehicle, Enter Lessee Information Below
Name(s) / Company
20. License # Date of Birth
21. FID#
22. Address
City State Zip
RMV Use Only: New Plate Type: New Plate #: Effective Date:
Total Fee: Clerk ID: Batch #:
16. Mail Address City State Zip Code
17. Residential Address (if different) City State Zip Code
26. If Change of Insurance Company, Enter Name and Code # of Previous Carrier
Here
18. I Have Changed:
� My Name � Motor Power � Reg From ____________________________________________________________________
� My Address � Gross Weight � VIN
� Garaging � Color � Other
� Use � Lessee (See Below) To ______________________________________________________________________
28. Policy Type
Personal
�
Commercial �
� Cash � Check � EFT/CC
Payment Method:
T21817-1212
