Form TC 96-167: Affidavit for Replacement or Non-Exchange

Enter the county after Affidavit for Replacement County.

After I CERTIFY THAT MY, mark Certificate of Registration, Registration Plate or Decal, and mark Lost, County Change, Stolen, Destroyed, Rusted or Other.

Fill in Describe and the number after I hereby request a replacement for Registration Certificate, Registration Plate, or Decal #.

Enter Owner(s) Name and ID (SSN or DL#) for each owner.

Enter the Street Address, City, State and Zip.

Sign on a Signature line and enter its Date; each Signature line has its own Date.

Enter the county after Affidavit for Non-Exchange County.

Enter the Title or Registration CTL #.

Mark the action you certify, based on the following title action: Repo, Junked Vehicle, Salvage Title or Title Only Transfer; or the registration action: Plate Replacement, Vehicle Type Conversion, Registration Conversion or Registration Cancel.

Enter the VIN, Plate and Decal, and mark the non-exchange reason the License Plate assigned to the motor vehicle or owner does not accompany the associated documents related to the aforementioned action: Lost, Special Plate, Stolen, Out of State, Destroyed or Other.

Fill in the Describe lines.

Enter the Name of Company or Dealership and its ID (SSN or DL#), and the Owner(s) Name and ID (SSN or DL#).

Enter the Lending Institution, Street Address, City, State and Zip.

Sign on Signature of Authorized Representative or Owner's Signature, and enter the Date.

Notary for Replacement or Non-Exchange: Subscribed and attested before me on this date, My commission #, My commission expires, and Attesting Official or Notary Signature and Title.