PENNSYLVANIA REGISTRATION RENEWAL APPLICATION ay -t05 (01-15) (Gtfog and woes to dary ‘Stop 3 - VETERANS’ TRUST FUND (VTF): asTusse74ess0 NOTE: P.0. Box numbers may be us Step 1- ODOMETER AND INSURANCE INFORMATION: Detschthe application below atthe perforation Pease provide the vehicle's current ocometor reading and insurance information i the epsoee provided, The NAIC number's a five digt, unique number assigned By tho Nationa! Aeteelaton of Ineurance Commesionere Canial inavte. the NAIC rumber i on yourinsurance card lease fat n he space provided. your umber tat lated on your |D card, cortas your nsuranoe agent ff aefnsured, FSELF-NSURED” in he insurance Company Name block and your sel'nauranee corte numer the Poloy "Number look, ohio ingurance mo! be maintained ala imes onal vad vehicle ragitrabons. A lapse i ‘nauranes coverage could result in suspension of vehicle rogitravon prvdages ler three month ‘Step 2- ORGAN DONATION AWARENESS TRUST FUND (ODTF): Youhove an epportunity to contribute an _icnal $1 tothe ODTE. Your contusion tothe Fund wil help increase publ ewareness of organ donation and help fave ves. Since this adtional §1 fant part f the renewal fee ried on your eophction lor, please add # to your payment Also, be sure to check the proper Bock he form te make sure your contribton s handled propery. ‘You have an opportunty o make a tx decutbe contribution tote VIF Yeu sortribuion wil help support programs and projects for Pennsjvaria veterans altho ames. Since this citona! $9 is no pat of the renewal fe pinod on your iva! renawal aopleation belo, ploase aid the donated armount foyourpsymentAlao, please check the proper block on the form below to make sure your sontabution i handled propery, Step 4- CHANGE OF ADDRESS INFORMATION: Pisste note he the change of adctees information bloc. ‘below need only be changed when your address istes below tere kom your actual adres, in action to th cual acess but cannot be used asthe cnly adress. You ‘may also change your address online at PeniDOTe Diver and Vehise Sevices Center at WWWW.OMW STATE PAUS Step 5- COMPLETING YOUR RENEWAL APPLICATION: You must sign the form below exacty as your nae(s) appear. the vehicle is in the name ofa companyicorporation, te signature ofan autotized representative is equred Use the enclosed arvelape fo farn yout & renewal apalsalion, along wit your oheoi/maney oxdor ‘made payable to the "Corsmorwealt of PennayivaniaIl tho envelope placed, mal to tre Bureau of Motor Vehicles, Hamsbug, PA 17104-2516, Visit us at www.dmy.state,pa.us or call us at: In State: 1-800-932-4600 TDD: 1-800-228-0676 Out-of-State: 1-717-412-8300 TDD Out-of-State: 1-717-412-5380 Detach At “OLD, OR MUTILATE Detach At Perforation ES Cm | or ov |22e7| sem, | put sn zene] 0 Ttefaroer TL wicetiathsien tant | tice tite | Tre [tea | “reenter | Erte | mpc. com.cn ry foarte oo a sae 2. Ere SaroRSEMRECENS [ | Reeacewe | ifpaoececoeete Misa t Sa SEERA RES MOLLY PITCHER HWY SHIPPENSBURG PA 17257 LRA I] O02@b07122765975508004300 YOUR ADDRESS: CHANGE:ONEY ear are Pe err ‘OwneriGo-Owner Sign Here Phone #