Form No. WVSP-MVI-4E
(Issued 10/2015)
WEST VIRGINIA
STATE POLICE
EXCHANGE FOR OFFICIAL
INSPECTION STICKERS
DATE
MAIL TO: West Virginia State Police
Traffic Records Section
701 Jefferson Road
So. Charleston, WV 25309
(Station Number)
(Signature of Authorized Person)
(Name of Official Station)
(Mailing Address)
(City)
(Zip Code)
Phone #
Motor Vehicle Stickers
Quantity:
THIS LINE FOR
DEPARTMENT USE ONLY
Motorcycle/Trailer Stickers
Quantity:
THLS LINE FOR DEPARTMENT USE
ONLY
Modified Vehicle Stickers
Quantity:
THIS LINE FOR DEPARTMENT USE ONLY
CHECKED BY:
DATE:
DATE STICKERS MAILED:
EXCHANGE ONLY
ALLOW THIRTY (30) DAYS FROM THE DATE OF RECEIPT FOR DELIVERIES.
A MAXIMUM OF 100 STICKERS MAY BE EXCHANGED PER STATION
EXCHANGE PERIOD IS FROM FEBRUARY ls' THROUGH APRIL 31 51
NOTE:
Unless the Name and Address above is correct the Department will not be responsible
for delivery of stickers. Use exact name and address as it appears on Station License.