Form Mv-82 - Application For A Parking Permit Or License Plates Page 2

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CHANGES

- Write new information about a current registration or title on page 1 of this form (for more information, refer to form MV-82.1,

“Registering/Titling a Vehicle in New York State”.)

NAME CHANGE: Print the former name exactly like the former name is printed on the current registration or title.

CHANGES: Describe any vehicle changes and the reasons for the changes.

ADDITIONAL VEHICLE INFORMATION

QUESTIONS 1-3 MUST BE COMPLETED.

1. I certify that, to the best of of my knowledge, this vehicle

has been or

has not been wrecked, destroyed or damaged to such an extent that

the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal

operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of loss.(Checking the “has been” box means the

vehicle must have an anti-theft examination before being registered, and that the title issued will have the statement “Rebuilt Salvage” on it.)

2. Is this vehicle registered for your personal use?

Yes

If you marked “Yes”, go to the next question (question 3) . If you marked “No”, check any of these boxes that apply:

This vehicle is a passenger vehicle that will be used for hire with a driver and will be operated in the following location(s):

New York City (NYC)

A jurisdiction that is not NYC that regulates taxis

A jurisdiction that does not regulate taxis

This vehicle is a passenger vehicle that is rented without a driver.

This vehicle requires a permit for commercial operation. (Mark the box of the type of permit that was issued and write the permit number on the line.)

NYS DOT Permit No. _________________

Federal DOT Permit No. _________________

The government owns this vehicle.

This vehicle is used as (mark one)

an ambulance

an ambulette

a hearse or invalid coach

If payment is received to carry passengers, mark this box.

This vehicle is used exclusively as a hearse

If payment is received to carry passengers, mark this box.

This vehicle is a commercial tow truck with a gross vehicle weight rating of at least 8,600 pounds.

This vehicle is used only as a farm vehicle. (form MV-260F, Part 1, must be attached)

This vehicle is used only as an agricultural truck.

This vehicle is subject to the Department of Transportation inspection requirements for the carriers that transport passengers. (For more

information, refer to form MV-82.1P, “Inspection Requirements for Carriers Transporting Passengers”.)

3. Has this vehicle been modified to change its registration class?

Yes

If “Yes”, explain _____________________________________

_______________________________________________________________________________________________________________________

4. This vehicle is a pick-up truck with an unladen weight that is a maximum of 6,000 pounds. This vehicle is never used for commercial

purposes and does not have advertising on any part of it. I want (mark one):

Passenger Plates

Commercial Plates

CERTIFICATION:

The information I have given on this application is true to the best of my knowledge. I certify that the vehicle is fully equipped as

required by the Vehicle and Traffic Law, and has passed the required New York State inspection within the past 12 months, or has qualified for a time

extension (Form VS-1077) and will be inspected within 10 days. I also certify that appropriate insurance coverage is in effect, and that the vehicle will be

operated in accordance with the Vehicle and Traffic Law. If I am applying for replacement registration items, I certify that the registration is not currently

under suspension or revocation. If I have plates in a series reserved for a special group, I certify that I am still eligible to receive them, and that I have

only one set of these plates. If I am using a credit card for payment of any fees in connection with this application, I understand that my

signature below also authorizes use of my credit card.

Print Name Here

Sign Here

(Print Name in Full - if registering for a corporation, print your full name and title)

(Sign Here)

Print Additional

Additional Signature

Name Here

Sign Here

(Print Name in Full)

(Sign Here - Additional signature required for a partnership or

if registering this vehicle in more than one name.)

IMPORTANT:

Making a false statement in any registration application or in any proof or statements in connection with it, or deceiving or substituting in

connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in the revocation or suspension

of the registration pursuant to regulations established by the Commissioner. The Department makes no representation that it will issue a certificate of title

or transferable registration until the Commissioner is satisfied that the applicant is entitled to a certificate of title or transferable registration, and until all

documentation required to establish ownership of the vehicle is submitted and deemed to be satisfactory. Pending review of this application, neither the

Commissioner of the Department of Motor Vehicles nor any of his or her employees, deputies or agents assumes any liability or responsibility for repairs

performed, improvements made or work done to the vehicle referenced in this application.

CREDIT CARD AUTHORIZATION IF CARDHOLDER IS NOT THE APPLICANT:

signature authorizes __________________________________________

Sign

to use my credit card for payment of fees in connection with this application,

Here

and I understa nd that I must be present for this transaction.

(Cardholder-Sign Name in Full)

To Be Completed by a Registered New York State Dealer Only – List any additional Lienholders

Lien Filing Code

____________________________________

Lienholder Name