Form Mv-512 - Return Product Form

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MV-512 (8-10)
Return Product Form
Bureau of Motor Vehicles
See Instructions on
Return Tag Unit
1101 South Front Street
Reverse Side of Form
Harrisburg, PA 17104
For Department Use Only
r
r
r
OLRP Business Partner
On-Line Messenger
PennDOT
r Expired
r Business Changes
r Business Closing
r Damaged
r PA00000
r Cancellation of On-Line Service
Business Name: __________________________________________________________________
BUID Number: __________________
Site Number: ____________________
Telephone Number: (_____)____________
Date of Return: __________________
Signature of Person Returning Product: ______________________________________________
PRODUCT
PRODUCT
PRODUCT
DESCRIPTION OF PRODUCT QUANTITY BEGINNING
ENDING
CLASS
TYPE
ISSUE
NUMBER
NUMBER
02
01
02/10
Renewal Sticker
50
349077
349126

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