Mv 78B Form Blank Details

Ready to learn more about the Mv 1441 3 form? You've come to the right place! In this blog post, we'll discuss everything you need to know about this document. We'll provide a detailed overview of what the form is used for and explain how to complete it correctly. Plus, we'll answer any questions you may have along the way.

These are some facts you may want to go over prior to starting working with the mv 1441 3.

QuestionAnswer
Form NameMv 1441 3
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names1441 3 form, mv 78b pdf, mv 1441 3, nys police mv 78b

Form Preview Example

CERTIFICATION OF LOST LICENSE, PERMIT OR PLATES

Use this form to explain why you can’t turn in your driver license, learner permit or license plates to DMV.

Your license and/or registration may be restored to you after you serve a suspension or revocation period. In most cases, the date you give this form to DMV will begin your compliance with the suspensionor revocation. If the effective date of theorder is laterthan the dateDMVreceivesthisform,yourcompliancewillbeginonthateffectivedate.

Instructions:

Providealltheinformationrequestedbelow.Pleaseprintyournameandmailingaddressexactly as they are printed on

your driver license, learner permit or vehicle registration.

Putacheckintheboxnexttoeachoftheitemsbelowthatyoucan’tturnintoDMV.

Inthe“Explanation”section,explainwhyyoucan’tturnintheitemsthatyoucheck.

Signinthe“Customer’sSignature”box,andreturnthisformtoanyDMVoffice.

Filingthisformwillinvalidatetheitemsthatyoucheckbelow(documentsand/orlicenseplates).Ifyoufindyoursuspended/ revokeddriverlicense,learnerpermitorlicenseplatesafteryougivethisformtoDMV,youmustimmediatelyturnintoa DMVofficeanyitemsthatyoufind.

Name __________________________________________________

DateofBirth:

/

/

MailingAddress __________________________________________________

 

(Month/Day/Year)

 

 

 

__________________________________________________

ClientID# ______________________________

__________________________________________________

(orFEINif

 

 

acorporation)

 

 

Iamunabletoturninthefollowingitem(s)totheDepartmentofMotorVehicles:

oPhotoDriverLicense

oInterim/TemporaryDriverLicenseorLearnerPermit

oLearnerPermit

oLicensePlates(pleasewritetheplatenumberhere)____________________________.A police report and form MV-78B (Report of Lost, Stolen or Confiscated Motor Vehicles Items) must be provided if you have reported the plates stolen, or if both plates have been lost, and the vehicle registration is not yet expired. If one plate has been lost, the remaining plate must be turned in.

VehicleIdentificationNumber____________________________________Year_________Make_____________________

Explanation:

_____________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________

Certification: Underthepenaltyofperjury,Icertifythat,tothebestofmyknowledge,theexplanationaboveistrue.

Customer’s Signature

Date

/ /

WARNING: FALSE STATEMENTS ARE PUNISHABLE UNDER SECTION 210.45 OF THE PENAL CODE. DRIVING A MOTOR VEHICLE WHILE YOUR LICENSE OR REGISTRATION IS SUSPENDED OR REVOKED IS A MISDEMEANOR,ANDISPUNISHABLEBYLAW.

MV-1441.3 (4/15)

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