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Form T-226I (Rev. 10-12)
Web and MV Manual
Registration Extension Request Affidavit
_______________ ____ ________________________________________________________________
Purpose of this form: This affidavit is to be used by a vehicle owner to request an extension no greater than 30 days on the
initial registration period for a motor vehicle that has been purchased but the transferor has not provided the purchaser or other
transferee owner with a title to the motor vehicle more than 5 business days prior to the expiration of such initial registration.
How to submit this Form: This fully completed form must be submitted along with the required item(s) below to your local
County tag office. Please refer to our website at
etax.dor.ga.gov to locate the address(es) for your specific County.
Additional requirements in order for this form to be processed:
Bill of Sale
I/we____________________________ purchased the motor vehicle described below from ____________________________
Purchaser’s Name
Transferor/Seller
on ___/____/_____. It has now been at least twenty-five days (25) since the date of this purchase. I/we do not have a license
plate for this motor vehicle and the title has not been issued in my/our name for this 1986 or newer motor vehicle that is
required to be titled.
I/We attest that this affidavit is being submitted to _______________________County tag agent with a request that shall grant
County Name
an extension of the initial registration period due to the title for the vehicle below not being provided due to the failure of a
security interest or lienholder to timely release a security interest or lien in accordance with Code Section 40-3-56.
I also acknowledge and understand that any false statement(s) submitted is punishable under the law and may result in a
denial of my request.
Signature: ___________________________________Date: _____/_____/_______
Owners’ Full Legal Name
Mailing Address
(
)
State
Zip
Telephone #
City
Owner(s)’ Full Legal Name(s)
(If Secondary Owner(s) are listed)
Mailing Address
(
)
Zip
State
Telephone #
City
VEHICLE INFORMATION:
Year
Make
Model
_____/_____/_____
Purchase Date
VIN
Insurance Company
Name
_____/_____/_____
Insurance Expiration Date
Policy #
STATE OF GEORGIA
COUNTY OF ________________
Sworn to (or affirmed) and subscribed before me this _____ day of __________, 20___, by
(__________________________)
(NOTARY STAMP OR SEAL)
Notary Signature