Form Mv-9db - Disabled Person'S License Plate Affidavit For A Business

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Disabled Person’s License Plate Affidavit for a Business
MV-9DB
(Rev. 06-2008)
Section One-Except for signature(s), this form must be typed, electronically completed and printed or legibly hand printed.
Note: Apply at the Tag Office in the county in Georgia where the business is located.
Business Corporate Name, LLC or Sole Proprietor
State Tax ID Number
Business Owner’s Street Address including City, State & Zip
County Where Business is Located
Disabled Person’s Full Legal Name
( Please attach an MV-9D, Disabled Person’s Affidavit)
Is Business Vehicle Used Only or Primarily by Disabled
Employee? Check only one box.
□ Yes
□ No
Disabled Person’s Street Address including City, State & Zip
Section two-Vehicle Information: The vehicle owner information is required when applying for a DP license plate for a business.
Vehicle Year & Make
Vehicle Identification #
Vehicle Color
Vehicle Tag #
Officer’s Signature and Position
______________________________________________
______________________________________________
Printed Name
Position
______________________________________________
______________________________________________
Signature
Signature Date
Note: Notarization Required For Authorized Representative’s Signature
Sworn to and subscribed before me
Notary Public’s Signature & Notary Seal or Stamp
My Notary Commission Expires:
This __________day of ______________________, _____________
(Day)
(Month)
(Year)
Date:__________________________
Instructions:
Except for signature(s), this application must be typed, electronically completed and printed or legibly printed
by hand for signing and submission.
Section One
Record the Business Corporate Name, LLC or Sole Proprietor and State Tax Id Number.
Record the Business owner’s street address including the city, state and zip code.
Record the county name where the business is located.
Record the disabled person’s full legal name and check the box to indicate that the business vehicle
is used primarily by disabled employee.
Record the disabled person’s street address including city, state & zip.
Section Two
Record the description of the vehicle, e.g. vehicle year and make, vehicle identification number,
vehicle color and vehicle tag number.
An officer of the business must sign and enter his/her position or job title with the business and
date.
Retention Schedule: This form will be retained at the County Tag Office for two (2) years from the date issued.

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