Division Of Motor Vehicles - Change Of Address Notice
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1401 – 462 - 4368 (4DMV)
NOTICE:
The LAW requires YOU notify the DIVISION OF MOTOR VEHICLES
within TEN (10) DAYS of any change of address.
LICENSE/ID NUMBER
REGISTRATION
DISABILITY PLACARD NUMBER
DATE OF BIRTH
REG TYPE
PLATE NUMBER
MONTH
DAY
YEAR
FIRST NAME
MIDDLE NAME
LAST NAME
FULL NAME
(please print)
PLEASE PRINT CORP. NAME AS IT APPEARS ON REGISTRATION
IF REGISTRATION IN NAME OF
COMPANY OR CORPORATION
STREET AND NUMBER
CITY/TOWN
ZIP CODE
OLD RHODE ISLAND
RESIDENCE ADDRESS
STREET AND NUMBER
CITY/TOWN
ZIP CODE
NEW RHODE ISLAND
CANNOT BE P.O. BOX !
RESIDENCE ADDRESS
(where vehicle is kept or stored)
STREET AND NUMBER
CITY/TOWN
ZIP CODE
NEW MAILING ADDRESS
(if different than residence)
PLEASE LEAVE A NUMBER WHERE WE CAN CONTACT YOU IF APPLICATION IS ILLEGIBLE OR INCOMPLETE
TELEPHONE NUMBER
(required)
E-MAIL ADDRESS
DATE MAILED
MONTH
DAY
YEAR
ADDITIONAL REGISTRATIONS
REG TYPE
PLATE NUMBER
I, the undersigned, declare under penalty of perjury that all statements made on this
REG TYPE
PLATE NUMBER
application for address change are true and complete to the best of my knowledge
and belief.
PERSONAL INFORMATION CONTAINED IN YOUR MOTOR VEHICLE RECORD WILL BE
DISCLOSED ONLY IF THE STATE HAS OBTAINED THE EXPRESS CONSENT OF THE
PERSON TO WHOM SUCH PERSONAL INFORMATION PERTAINS.
YES
NO
DO YOU CONSENT TO SUCH DISCLOSURE?
SIGNATURE IN FULL
(DO NOT PRINT)
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
MAIL TO:
DIVISION OF MOTOR VEHICLES
600 New London Avenue
Cranston, RI 02920-3024
Attention: ADDRESS CHANGE
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