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Pa Mv141 Form PDF Details

If you're a small business owner in Pennsylvania, you may be wondering whether you need to complete and submit a PA Mv141 form. This article will provide an overview of the PA Mv141 form and answer some common questions about it.

You can find information about the type of form you need to complete in the table. It will show you just how long it takes to complete pa mv141 form, exactly what fields you will need to fill in, etc.

Question	Answer
Form Name	Pa Mv141 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	form mv141, pa form mv141, mv141, mv 141 form pa

12

Form Preview Example

MV-141 (4-18)

SURRENDER OF A REGISTRATION PLATE

Bureau of Motor Vehicles • 1101 S. Front Street • Harrisburg, PA 17104

www.dmv.pa.gov

For Department Use Only

Registration Plate Must be Attached

A

Applicant and Vehicle Information

NOTE TO VEHICLE OWNER: You must retain a copy of this receipt in order to obtain a replacement registration plate from an authorized agent.

Name of Registrant

Registration Plate Number

Title Number

B

The above registration plate is being returned to PennDOT for the following

reason(s):

1.q Replacement of Registration Plate

5. qMoved Out-of-State

9.

qTermination or Lapse of Insurance

2.q Vehicle Sold (no plate needed)

6. qInsurance Stop

10. qRegistration Privileges Suspended

3. q Voluntary Surrender

7. qVehicle Deal Cancelled

11. qOther:____________________________

4. q Personalized Registration Plate - Issued _____ 8. qExchange Registration Plate Issued

C

Decentralized Service or Full Agent Information (If applicable)

The registration plate listed above was surrendered on _______________ to the authorized agent below:

Decentralized Service or Full Agent Name

Date

City

State

Zip Code

Street Address

I certify that I have verified that the number listed on the registration plate matches the registration plate number listed above and hereby certify

under penalty of law that

ALL information contained herein is TRUE and CORRECT and that I 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]).

______________________________________________________

______________________________________________________

_________________________

Printed Name of Authorized Agent

Authorized Agent Signature

Date

D

Law Enforcement/PennDOT Locations

The registration plate listed above was surrendered on _______________ to the authorized agent below:

Law Enforcement/PennDOT Location Name

Date

City

State

Zip Code

Street Address

I certify that I have verified that the number listed on the registration plate matches the registration plate number listed above and hereby certify

under penalty of law that

ALL information contained herein is TRUE and CORRECT and that I 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]).

______________________________________________________

______________________________________________________

_________________________

Printed Name of Authorized Person

Authorized Person Signature

Date

E

Registration Plate Owners

I/We are surrendering the above listed registration plate to the Department on _______________.

Registration Plate Owner Name

Date

City

State

Zip Code

Street Address

I/We certify that I/we have verified that the number listed on the registration plate matches the registration plate number listed above and hereby

certify under penalty of law

that ALL 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]).

_____________________________________________________

_______________________________________________

________________________________

Printed Name of Registration Plate Owner

Owner Signature

Date

_____________________________________________________

_______________________________________________

________________________________

Printed Name of Registration Plate Co-Owner

Co-Owner Signature

Date

NOTE TO VEHICLE OWNER: You must retain a copy of this receipt in order to obtain a replacement registration plate from an authorized agent.

FOR DEPARTMENT USE ONLY

Agent/Messenger No.

Date Received

Month

Day

Year

INSTRUCTIONS

1. Complete Section A with the vehicle owner’s information exactly as it is listed on their registration card.

2. In Section B, check appropriate reason the registration plate is being returned to PennDOT. NOTE: The registration plate must be attached.

3. If the surrendered registration plate is being surrendered to an authorized decentralized service agent or full agent, Section C must be completed by the authorized decentralized service agent or full agent and forwarded to PennDOT along with the registration card and registration plate. Decentralized service agents must forward through the Messenger Service Center. A copy of this form must be retained by the authorized agent for at least three years. A copy of this completed form must be provided to and retained by the vehicle owner and may be necessary to obtain a replacement registration plate, if needed at a later date.

4. If this form is completed at a PennDOT location or by a law enforcement officer, the PennDOT representative or law enforcement officer must complete Section D of this form and the registration plate must be mailed to: Bureau of Motor Vehicles, P.O. Box 68597, Harrisburg, PA 17106-8597.

5. If this form is completed by the registration plate owner, the registration plate owner must complete Section E of this form and the registration plate must be mailed to: Bureau of Motor Vehicles, P.O. Box 68597, Harrisburg, PA 17106-8597. A copy of this completed form must be retained by the vehicle owner and may be necessary to obtain a replacement registration plate, if needed at a later date.

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

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The system will demand you to prepare the Street, Address City, State, Zip, Code Printed, Name, of, Authorized, Person Authorized, Person, Signature Date, E, Registration, Plate, Owners Date, Registration, Plate, Owner, Name Street, Address City, State, Zip, Code Printed, Name, of, Registration, Plate, Owner Owner, Signature CoOwner, Signature Date, and Date box.

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