Form Mv 353 PDF Details

Mv 353 is a form used to apply for a Certificate of Motor Vehicle Insurance. The form is also known as the Green Card, and it serves as evidence that you have motor vehicle insurance coverage. The certificate must be carried in the vehicle at all times when the vehicle is being operated on public roads. The information requested on the Mv 353 includes your name and address, the make and model of your car, and the dates of coverage. The insurance company will also need to know your policy number and whether you want full or third-party liability coverage. You will also need to provide your driver's license number, social security number, and date of birth. If you are moving to a new state, you will need to update your information on file with the Department of Motor Vehicles. You can do this by filling out a new Mv 353 form and sending it to the appropriate agency. Make sure you include your old policy number so that they can easily verify your coverage. The Certificate of Motor V

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Form NameForm Mv 353
Form Length2 pages
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Avg. time to fill out30 sec
Other namesmv353 form, mv 353, amazon, mv 353 ny

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MV-353 (7-19)

www.dmv.pa.gov

APPLICATION FOR REPLACEMENT OF DEALER OR MISCELLANEOUS MOTOR VEHICLE BUSINESS REGISTRATION PLATE OR REGISTRATION CARD

For Department Use Only

Bureau of Motor Vehicles • P.O. Box 68283 • Harrisburg, PA 17106-8283

CHECK (4) APPROPRIATE BLOCK

r Replacement of Dealer/Miscellaneous Motor Vehicle Business (MMVB) Registration Plate - Complete SectionsA, B, D or E (if applicable). - Fee is $11 for each replacement.

r Request for Duplicate Registration Card(s) - Complete SectionsA, C and D or E (if applicable). - Fee is $6.

ADEALER/MMVB INFORMATION

 

Dealer/Business Partner Identification Number

Registration Plate Number

 

 

 

 

Business Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Business (Exactly as it appears on your registration card)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business StreetAddress

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B APPLICATION FOR REPLACEMENT DEALER/MMVB REGISTRATION PLATE - Check (4) appropriate blocks.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rRegistration Plate Number: _________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

r*Lost

 

r*Stolen

rDefaced

rNever Received

rOther: ________________________

 

 

 

REASON:

 

 

 

 

 

*If the registration plate is lost or stolen, it must be reported to the State Police or your local law enforcement office.

 

 

 

 

 

Incident Number

 

 

Date of Incident

 

Law Enforcement Station Name

 

Law Enforcement Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Law Enforcement Officer First Name

 

 

 

 

 

 

 

 

Law Enforcement Officer Last Name

 

 

 

 

 

 

 

 

 

 

NOTE: In conjunction with replacement of your registration plate, you will receive one registration card. If additional registration cards are

 

 

 

 

desired, the fee is $2 for each card. Number of duplicate registration cards requested @ $2 each: _________.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C APPLICATION FOR DUPLICATE REGISTRATION CARD(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rLost

 

rStolen

rDefaced

rNever Received

rOther: ________________________

 

 

 

REASON:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of duplicate registration cards requested at $6 each. (You must use a separate form for each registration plate number unless

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

you are requesting duplicate registration cards for all renewed dealer registration plates in your possession).

 

 

 

 

 

 

 

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rRequest duplicate summary cards for all currently renewed dealer registration plates.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

CERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I/We hereby certify under penalty of law thatALL information contained herein is TRUE and CORRECT and that I/we understand that any misstatement of

 

 

 

fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature ofAuthorized Signer

 

 

 

 

 

 

 

 

Title ofAuthorized Signer

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

APPLICATION FOR FREE ISSUANCE - Complete only if applicant is entitled to free issuance because original was lost in the mail and

application is being made within 90 days of original issuance under Section 1902(2) of the Vehicle Code.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBSCRIBEDAND SWORN

 

 

 

 

 

 

 

I hereby state that application was made for the above registration plate or

 

TO BEFORE ME:

 

MONTH

DAY

 

 

 

YEAR

that the items as indicated were never received due to loss in the mail.

 

T

SIGNATURE OF PERSONADMINISTERING OATH

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature ofApplicant (Dealer orAuthorized Person)

 

 

 

 

 

T

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

SIGN IN PRESENCE OF NOTARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name asAbove

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSTRUCTIONS

1.Application for replacement of registration plate must be made within 48 hours of discovery of the loss or defacement of the registration plate. If registration plate(s) is lost or stolen, it must be reported to the police.Acopy of the police report or incident number must be attached to this form.

2.If requesting replacement of more than one registration plate, a separate form must be used for each registration plate.

3.If the registration plate or registration card was never received, and application for replacement is made within 90 days from date of issuance, no fee is required. Compete Section E.

4.DO NOT SEND CASH. Make check or money order payable to the Commonwealth of Pennsylvania.

5.Mail application to: PennDOT

Bureau of Motor Vehicles

P.O. Box 68283

Harrisburg, PA17106-8283

6.Dealer registration plates may be personalized. Should you choose to personalize your replacement dealer registration plate, please complete and attach Form MV-904D, "Application for Personalized Dealer Registration Plate," to this application. NOTE: There is an additional $108 fee required with personalization requests.

Visit us at www.dmv.pa.gov or call us at 717-412-5300. TTYcallers — please dial 711 to reach us.

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