Fillable Vehicle Registration Authorization Fillable (City of Golden Valley)

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Vehicle Registration Authorization Fillable (City of Golden Valley)

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Authorization To Register My Vehicle With The City Of Golden Valley
Instructions:
1. Call DVS at 651-297-2126 to get the tab renewal amount. Record amount here: $_______________
2. Place this completed form and payment in the Utility Drop Box near the front door of City Hall or mail to: Golden Valley DMV, 7800 Golden Valley Rd,
Golden Valley, MN 55427.
Vehicle Description
Plate # Year Make VIN or Title #
Insurance company name Policy number Current expiration date
Vehicle Owner’s Name And DL # (Required)
Signature
Signature of owner
X
Date
Note: if vehicle has been parked and not used recently, please sign non-use statement verifying last used.
Signature of owner
X
Non-use date
to
Department | 7800 Golden Valley Road, Golden Valley, MN 55427
763-593-8055 | FAX: 763-593-8109 | TTY: 763-593-3968 | www.goldenvalleymn.gov
This document is available in alternate formats upon a 72-hour request. Please call 763-593-8006 (TTY:
763-593-3968) to make a request. Examples of alternate formats may include large print, electronic,
Braille, audiocassette, etc.
4/15/20
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Vehicle Registration Authorization Fillable (City of Golden Valley)

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Completed 14 July 2020

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