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POLICE
SECRETARY OF STATE
VEHICLE REGISTRATION
AND/OR TITLE REVOCATION REQUEST
3650 Winchester Rd.
Springfield, IL 62707
FAX: 217-782-2896
(Please print clearly or type)
TYPE OF REVOCATION (check one):
J
J
License plates only
Title only
Vehicle Identification Number:
License Plates Number:
Vehicle Year:
Vehicle Make:
Title Number:
Last Name:
First Name:
Middle Initial:
First Name:
Middle Initial:
Last Name:
Address:
City:
ZIP Code:
Telephone Number:
Driver’s License Number:
State:
REASON FOR REVOCATION (check one):
J
J
Vehicle sold with plates
New owner failed to transfer title (Title revocation only)
J
J
Owner moved out of state
Divorce (Clear copy of divorce decree required)
J
J
Plates lost, destroyed or disposed of
Owner deceased (Clear copy of death certificate required)
J
J
Vehicle donated to charity
Non-possession of plates
J
J
Vehicle towed/junked with plates
Vehicle/plates stolen (Clear copy of police report required)
J
Vehicle repossessed
REGISTERED OWNER’S SIGNATURE(S):
(Signatures of all registered and/or titled owners are required. Leased vehicles must include the lessor’s signature before request is accepted.)
___________________________________________________
_____________________________________________
Registered owner’s signature
Date
___________________________________________________
_____________________________________________
Registered owner’s signature
Date
Each request must include the correct owner and vehicle information, reason for revocation and signature(s) of the registered owner(s). Failure to include
this information will prevent the request from being processed. Vehicle registration and/or title revocation does not remove your name from the record.
Please mail or fax to the address above.
Printed by authority of the State of Illinois. October 2008 — SOS DOP 159.6