Mass Rmv Dealer Registration Under A

FID 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. 22. Address Insurance Company City State Zip 23.

As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details: Released on February 18, 2017; The latest edition provided by the Massachusetts Department of Transportation; Easy to use and ready to print; Quick to customize; Compatible with most PDF-viewing applications; Fill out the form in our online filing application.

Current Registration 3.

Title 4. Vehicle Identification Number (VIN) Other: 6.

Make 8. Model 9. Circle Color(s) of Vehicle 7.

ORANGE 3. BROWN 6.

GREEN 9. PURPLE 1.

BLACK 4. RED 7. WHITE 2.

BLUE 5. YELLOW 8.

GRAY 11. Trans 10.

CylPassDoorsWheels 13.

Name of Owner(s)CoCorpor Sole Proprietor Owner 1: Owner 2: 15.

Mass Rmv Dealer License ID Or

Owner 1 License ID or SSN Date of Birth EIN FID for CorpCoOrg or Sole Proprietor (if Sole Proprietor, also provide SSN) Owner 2 License ID or SSN Date of Birth EIN FID for CorpCoOrg or Sole Proprietor (if Sole Proprietor, also provide SSN) 16.

I Have Changed: From My Name Motor Power Reg My Address Gross Weight VIN Garaging Color Other Lessee (See Below) To Use 26.

If Change of Insurance Company, Enter Name and Code of Previous Carrier ehicle, Enter Lessee Information Below 19.

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 21.

Address Insurance Company City State Zip 23.

If Vehicle Used For Transporting Goods, Wares, or Agent Merchandise WT.

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 Total Gross Weight the applicant(s), any member of the applicants immediate family who is a member of the 24.

If School Bus, is it Used Exclusively Under Contract to City applicants household, or the business partner of the applicant(s).

The undersigned hereby Town School District 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.

Number of Passengers that can be Seated Owner 2 Signature RMV Use Only: New Plate Type: New Plate: Effective Date: Payment Method: Cash Check EFTCC Total Fee: Clerk ID: Batch: T21817-1212.