APPLICATION FOR REPLACEMENT PLATES, STICKERS, DOCUMENTS Apply Below Company Complete all sections of this form. YOUR INFORMATION True Full Name (Last, First, Middle) or Business Name * Email Address * Phone * Vehicle License Plate/CF Number * Make * Physical residence or business address (include St., Ave., Rd., Ct., etc.) Apt./Space/Ste.# * City * State * Zip * County of Residence or County Where Vehicle/Vessel is Primarily Garaged * Mailing Address (if different from physical above) City State Zip PLATES, STICKERS, DOCUMENTS REQUEST Check the appropirate boxes below. Note: For replacement of missing License Plate, License Sticker, or Disabled Person Placard, if the original item is later located or received, the original item is no longer valid and must be destroyed or returned to DMV. I am requesting replacement of: (check all that apply) License Plates Registration Card Year Sticker Month Sticker Vessel (Boat) Year Sticker Vessel Certificate of Number Vessel Mussel Sticker Disabled Person Placard Disabled Person ID Card Planned Non-Operation (PNO) Card PFR Sticker CVRA Weight Decal CVRA Year Sticker Trailer or OHV ID Card The item requested was: (check all that apply) Lost Stolen Destroyed/Mutilated (remnants/remains of the plate(s) must be surrendered to DMV) Not Received from DMV (Allow 30 days from issue date before reapplying) Not Received from Prior Owner Surrendered One plate to DMV Surrendered Two plates to DMV Special Plates were Retained by Owner (Personalized, Disabled Person, Disabled Veteran) Requesting Registration Card with Current Address Per CVC Section 4467 - Copy of a police report, court documentation, or other law enforcement documentation required. Other - Explain below Other Explanation CERTIFICATION The registered owner mailing address is valid, existing, and an accurate mailing address. I consent to receive service of process at this mailing address pursuant to CVC Section 1808.21, Cod of Civil Procedure Sections 415.21(b), 415.30(a), and 416.90. Required and Agreed: * By clicking on the Submit button below to submit this application, I certify and declare under penalty of perjury under the laws of the State of California that the information hereby submitted by me, the person indicated by the information entered above as the "True Full Name," is true and correct.