Form Mvr-614 - Affidavit Of Military/dependent Or Principally Garaged Vehicle

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Affidavit of Military/Dependent or Principally Garaged Vehicle
MVR-614
(Rev. 01/16
)
North Carolina Department of Transportation
Division of Motor Vehicles
I, _______________________________________________________________________, being first duly sworn or affirmed, do state:
My full legal name (including first, middle, and last) is _________________________________________________________
1.
I am an active duty service member or dependent; or, it is my intention to principally garage the vehicle described below
2.
in North Carolina pursuant to G.S. 20-52. (“Principally garaged” means the vehicle is garaged for six or more months of
the year on property in this State which is owned, leased or otherwise lawfully occupied by me.) I understand that I may
not be a resident of the State of North Carolina for registration purposes, but I am present in this state due to my active
military or dependent status; or I am not a resident and I am not present in the state due to active military or military
dependent status, but intend to principally garage my vehicle here in this State for six months or more in a single
calendar year pursuant to G.S. 20-52.
Vehicle Description
Year _____ Make________ Model _______
VIN _______________________________
Body Style ____________ Fuel _________
The address of the location where said vehicle will be registered and/or principally garaged is:
3.
_____________________________________________________________________________________
Address
City and Zip Code
4.
I understand it is a violation of the Motor Vehicle Laws of North Carolina to use a false or fictitious name or address or to
conceal a material fact in my application to verify my proof of residency. I also understand it is a Class I felony to make a false
statement under G.S. 20-112 and G.S. 20-71.
I understand I must notify the Division of an address change within 60 days after the change occurs to be in compliance with
5.
G.S. 20-67 and may no longer be eligible to keep the above-listed vehicle titled or registered in the State of North Carolina if
the vehicle is no longer principally garaged in this State or if my military or military dependent status or domicile changes to a
different state.
6.
I am a resident of the State of ______________________________ and my permanent address in this home state is as follows:
______________________________________________________________________________________________________
Address
City, State and Zip Code
My out-of-state Driver’s License/Identification Card number is _______________________ and is issued by my home State of
7.
____________________________ and attached is a copy of my Driver’s License/Identification Card issued by my home state.
I declare the foregoing is true and correct:
_________________________________________________________________________________________
Owner's Signature
Date________________ County__________________________________________ State of __________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the
purpose stated therein and in the capacity indicated: __________________________________________________________________________ (name(s) of principal(s))
Notary
Notary Printed
Signature _______________________________________________________
or typed Name __________________________________________________________
My Commission Expires __________________________________________________
(SEAL)
By checking here and signing below, I (dealer/LPA) certify that the applicant above has produced a military or military
dependent ID which appears to be valid, and I have examined same: __________________________________________.
Print/Sign

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