Form T-200 - Affidavit Of Non-Receipt Of An Original License Plate/renewal Decal
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1Form T-200 (Revised 08-2005)
Affidavit of Non-Receipt of an Original License Plate/Renewal Decal
(Submit to the Office That Issued the Original License Plate/Renewal Decal)
Year & Make Vehicle
Vehicle Identification Number (VIN)
Tag Number/Decal Number
Year Issued
This is to affirm that I applied for the original license plate/renewal decal for the above referenced vehicle and I
have not received this license plate/renewal decal. Apparently, this license plate/renewal decal was lost in the
mail.
According to: (Check one)
County Tag Office
State MVD this license plate/renewal decal was issued
and mailed to me at the address shown below.
Attached is a completed MV-7 application for a replacement license plate/renewal decal, a copy of the record
showing where this license plate/renewal decal was issued to me, and a copy of the police report where this
license plate/renewal decal was reported as missing.
Please issue me a replacement license plate/renewal decal at no charge. I realize that according to §40-2-114 of
the O.C.G.A., it is unlawful to make a false report required by the State Revenue Commissioner. I am also
aware that by making a false report that upon first conviction, I shall be punished by a fine of not less than
$25.00 nor more than $100.00; and upon a second or subsequent conviction, by a fine of not less than $25.00
nor more than $500.00, or by imprisonment for not more than thirty-days (30), or both
Sworn to and subscribed before me this
____
________________, ________
__________________________________
Of
(Day)
(Month)
(Year)
(Registered Owner’s Printed/Typed Name)
________________________________
___________________________________
(Signature of Notary Public or Justice of Peace)
(Registered Owner’s Signature)
________________________________
___________________________________
(Date Notary Commission Expires)
(Registered Owner’s Street Address)
__________________________________
(City, State & Zip)
__________________________________
(Date)
§40-2-44 of the O.C.G.A. allows for the issuance of a replacement license plate/renewal decal “free of charge”
when the original license plate/decal has been lost in the mail prior to the owner’s receipt. A completed and
signed MV-7 Application for a Replacement License Plate/Decal must accompany this completed affidavit. The
owner shall report the non-receipt or loss of the license plate or decal to the appropriate law enforcement agency
or official, including, but not limited to, a municipal or county police department of officer, the county sheriff, or
the Department of Revenue. Said owner shall obtain a copy of the police report on which the license plate or
renewal decal number is listed and shall submit such copy to the commissioner. The owner shall not be charged a
fee for a copy of such policy report.
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