Sun-Shading Removal
I certify that the sun-shading material has been removed from this vehicle.
Vehicle Owner
DATE (mm/dd/yyyy)
SIGNATURE OF PERSON WHO REMOVED SUN-SHADING
VEHICLE OWNER SIGNATURE
DATE (mm/dd/yyyy)
Identify each vehicle to have sun-shading material removed (List additional vehicles on reverse.)
VEHICLE INFORMATION
MAILING ADDRESS (If different from above)
CITY
STATE ZIP CODE
Year Make Model Title Number Identification Number (VIN) Plate Number
SUN-SHADING REMOVAL INFORMATION
BUSINESS NAME (print) NAME OF PERSON WHO REMOVED SUN-SHADING (print)
BUSINESS ADDRESS
TELEPHONE NUMBER
CITY
STATE ZIP CODE
I certify that the sun-shading material has been removed from this vehicle.
I certify that the sun-shading material was never installed on this vehicle by the previous owner.
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine,
and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under
penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.
CERTIFICATION
VEHICLE OWNER SIGNATURE
DATE (mm/dd/yyyy)
I certify that I have applied for sun-shading medical authorization and will retain the sun-shading material installed on this vehicle
by the previous owner. (Complete MED 20)
VEHICLE OWNER INFORMATION
VEHICLE OWNER NAME (last, first, mi, suffix)
DMV CUSTOMER NUMBER
BIRTHDATE (mm/dd/yyyy)
DAYTIME TELEPHONE NUMBER
RESIDENCE/HOME ADDRESS
CITY
STATE
ZIP CODE
SUN-SHADING REMOVAL
CERTIFICATION
MED 21 (07/01/2020)
Purpose: Use this form to report the removal of sun-shading from a vehicle and request a new registration card without
the sun-shading notation.
Instructions: Complete this form and return to any DMV customer service center, mail to DMV at the address above, or
fax to (804) 367-1384. DMV will issue a new registration card.
DMV USE ONLY
LOG NUMBER
