Pa Mv141 Form – Fill Out and Use

A Applicant and Vehicle Information
	Name of Registrant					VIN Number
	Registration Plate Number		Expiration Date			Title Number
			Mo.	Yr.
B The above registration plate is being returned to PennDOT for the following reason(s):
	q Replacement of Registration Plate		q Moved Out-of-State				q Exchange Plate Issued
	q Vehicle Sold (no plate needed)		q Insurance Stop				q Termination or Lapse of Insurance
	q Voluntary Surrender		q Vehicle Returned to Dealer Within 20 Days				q Registration Privileges Suspended
	q Vanity Tag - Issued _______________		q Vehicle Deal Cancelled				q Other______________________________
C Decentralized Service or Full Agent Information (If applicable)
	The registration plate listed above was surrendered on _______________ to the authorized agent below:
				(DATE)
	Decentralized Service or Full Agent Name					Street Address
	City					State		Zip Code

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

FOR DEPARTMENT USE ONLY					Agent/Messenger No.
Date Received
	Month	Day	Year

InstructIons

1.Vehicle owner and registration information must be listed in Section A exactly as shown on the vehicle owner's 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 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. Full agents must mail this form to PennDOT’s Bureau of Motor Vehicles, P.O. Box 68674, Harrisburg, PA 17106-8674. If completed by an authorized decentralized service agent or full agent, 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 will be necessary to obtain a replacement registration plate, if needed at a later date.

If this form is completed by the applicant, the form and registration plate must be mailed to the 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 will be necessary to obtain a replacement registration plate, if needed at a later date.

4.To obtain a replacement registration plate, applicants must provide a copy of this completed form to a decentralized agent or PennDOT's counter service in Harrisburg for a replacement.