Form MV-221 at a glance
What it is: Form MV-221 is the Statement of Non-Operation of Vehicle(s) of the Bureau of Motor Vehicles, with a section For Department Use Only.
Who signs: Enter the Signature of Owner or Authorized Signer and Date.
A filled-in Form MV-221 example: an owner certifies a 20-day lapse
How to fill out Form MV-221, box by box
Insurance Cancellation Date and Insurance Replacement Date
This statement is unacceptable if insurance lapse is greater than 30 days. All information must be completed by the vehicle owner only.
After I, write your Print Name, then the Insurance Cancellation Date and the Insurance Replacement Date; you hereby state that you did not operate or permit operation of the motor vehicle(s) between those Dates due to lapse in insurance coverage.
Application information
Under Application Information, enter the Last Name (or Full Business Name), First Name, Middle Name, PA DL/Photo ID#, Date of Birth and Telephone Number or Bus. ID#.
For a co-owner, enter the Co-Owner Last Name, First Name, Middle Name, PA DL/Photo ID#, Date of Birth and Telephone Number or Bus. ID#.
Vehicle(s) information
In each row under Vehicle(s) Information, enter the Title Number, Registration Plate Number, Vehicle Identification Number and Make.
Applicant signature
Misstatement of fact is a misdemeanor of the third degree punishable by a fine of up to $2,500.00 and/or imprisonment up to one year (18 Pa.C.S. Section 4904[b]) (checked October 21, 2026).
Enter the Signature of Owner or Authorized Signer and Date.
Under APPLICANT SIGNATURE, enter the Signature of Co-Owner/Title of Authorized Signer and Date.
Common questions about Form MV-221
Where do I file it?
Send the completed certification to PennDOT at: Mailing Address: Bureau of Motor Vehicles, PO Box 68674, Harrisburg, PA 17106-8674 Fax: (717) 772-1550 Email: FRInsurance@pa.gov.
Sources
[1] Form MV-221 (3-25), Statement of Non-Operation of Vehicle(s), Pennsylvania Department of Transportation (the Official source link on this page).
