Form Rmv-3 - Massachusetts Registry Of Motor Vehicles
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1
2Massachusetts Registry of Motor Vehicles
RMV-3 Form
P.O Box 55889
Boston, MA 02205-5889
1. � Renewal � Amendment
2. Current Registration #
3. Title #
4. Vehicle Identification Number (VIN)
� Other:________________
6. Make
8. Model #
9. Circle Color(s) of Vehicle
7. Model Name
5. Model Year
O. ORANGE
3. BROWN
6. GREEN
9. PURPLE
1. BLACK
4. RED
7. WHITE
2. BLUE
5. YELLOW
8. GRAY
11. Trans
10. Cyl/Pass/Doors/Wheels
13. Expiration Date
Month / Year
12. City/Town Vehicle is Principally Garaged
�
Auto
�
Manual
14. Name of Owner(s)/Co/Corp/or Sole Proprietor
Owner #1:
Owner #2:
15. Owner # 1 License # / ID # / or SSN ________________________________________
Date of Birth _______________________
EIN / FID# for Corp/Co/Org or Sole Proprietor (if Sole Proprietor, also provide SSN) _______________________________________________________
Owner # 2 License # / ID # / or SSN ________________________________________
Date of Birth _______________________
EIN / FID# for Corp/Co/Org or Sole Proprietor (if Sole Proprietor, also provide SSN) _______________________________________________________
16. Mail Address
City
State
Zip Code
17. Residential Address (if different)
City
State
Zip Code
18. I Have Changed:
From ____________________________________________________________________
� My Name
� Motor Power
� Reg
� My Address
� Gross Weight
� VIN
� Garaging
� Color
� Other
� Lessee (See Below)
To ______________________________________________________________________
� Use
26. If Change of Insurance Company, Enter Name and Code # of Previous Carrier
ehicle, Enter Lessee Information Below
19. If Leased V
Here
Name(s) / Company
28. Policy Type
27. Policy Effective Date
�
Personal
�
20. License #
Date of Birth
Commercial
Policy Change Date
29. The company signatory hereto hereby certifies that it has or will insure or guarantee
performance by the applicant herein before named with respect to the motor vehicle hereinbefore
21. FID#
described for a period of at least coterminous with that of such registration under a motor vehicle
liability policy, binder, or bond which conforms to the provisions of general laws chapter 175,
section 113A and that the premium charge and classification of the effective date of registration
are as established by the commissioner of insurance under chapter 175, section 113B.
22. Address
Insurance Company
City
State
Zip
23. If Vehicle Used For Transporting Goods, Wares, or
Agent
Merchandise
WT. of Vehicle Fully Equipped ________________
Insurance CO.’s Authorized Representative’s Signature/Date
Max. Load or Heaviest Semi-Trailer W ith Load ________________
30. I /We the applicant(s) hereby certify under the penalties of perjury that there are no
outstanding excise tax liabilities on the vehicle described above that have been incurred by
Total Gross Weight ________________
the applicant(s), any member of the applicant’s immediate family who is a member of the
24. If School Bus, is it Used Exclusively Under Contract to City /
applicant’s household, or the business partner of the applicant(s). ***The undersigned hereby
Town / School District?
further certify that all information contained in this application is true and correct to the best of
their knowledge and belief. False statements are punishable by fine, imprisonment, or both.
Yes
_______ No ________
Owner #1 Signature
_______________________________________________________________________
25. If Vehicle Carrying Passengers For Hire, Max. Number of
Passengers that can be Seated
Owner #2 Signature
___________________________________
_______________________________________________________________________
RMV Use Only:
New Plate Type:
New Plate #:
Effective Date:
Payment Method:
� Cash
� Check � EFT/CC
Total Fee:
Clerk ID:
Batch #:
T21817-1212
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