Form T-158 - Report Of And/or Surrender Of Georgia License Plate
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1T-158
WEB (Rev. 6/01)
REPORT OF AND/OR SURRENDER OF GEORGIA LICENSE PLATE
SECTION 1
Company/Person Surrendering License Plate
Reason for Report: (Check One)
( )
License Plate for the vehicle described below
surrendered for the reason indicated. (Check applicable reason in
Section 2 below.)
Authorized Agent Surrendering License Plate
( )
I declare that no tag was on the vehicle described
below. (Check applicable reason in Section 2 below).
( )
Tag unclaimed by owner, surrendered for
cancellation.
Mailing Address
Date of Surrender/Report:___________________
City
State
Zip Code
_________________________________________________________________________________________________
SECTION 2
Georgia Law (O.C.G.A. Section 40-2-20) requires that a license plate be surrendered when a Certificate of Registration is
not available for certain categories of vehicles. The vehicle described below is in the category or categories shown:
(Check Applicable Categories).
( ) COURT ORDER OR INVOLUNTARY TRANSFER
( ) SALVAGE
(If vehicle owner retains salvage vehicle, owner must surrender license plate.)
REPOSSESSION
( ) ABANDONED/DERELICT
(
)
Illegal use or transfer of a License Plate is a misdemeanor of a high and aggravated nature, punishable by a fine of not less than $500,00 or by confinement for not
more than 12 months, or both.
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
SECTION 3
VEHICLE AND TAG INFORMATION (All Spaces Must Be Completed)
DO NOT SURRENDER SPECIAL OR PRESTIGE LICENSE PLATES
Year Model & Make of Vehicle
Manufacturer’s ID Number (Complete ID# MUST BE SHOWN CORRECTLY)
License Plate number and year issued
DECAL NUMBER (If Applicable)
Decal Year
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
SECTION 4
METHOD OF DELIVERY: ( ) MAIL TO STATE
( ) MAIL TO COUNTY, COUNTY NAME:_________________________________________
(
) HAND DELIVERED TO STATE
( ) HAND DELIVERED TO COUNTY, COUNTY NAME:_____________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
SECTION 5
________________________________________________________
_____________________________________________________________________________
(Typed/Printed Name of person/Representative) (Date)
(Signature of Authorized Representative of Company or Person Surrendering License Plate
LICENSE PLATES AND FORM(S) MUST BE MAILED
IF NOT MAILED, LICENSE PLATE AND FORM(S) MUST BE
TO: COUNTY TAG OFFICE OR
DELIVERED IN PERSON TO: COUNTY TAG OFFICE OR
Motor Vehicle Division/Surrendered License Plates
Motor Vehicle Division/Window ‘A’
Post Office Box 740381 - Atlanta, Georgia 30374-0381
1200 Tradeport Blvd. - Hapeville, Georgia
_________________________________________________________________________________________________________________________________
ACKNOWLEDGEMENT OF RECEIPT OF THE ABOVE LISTED LICENSE PLATE
COUNTY
______________________________________________________________________________________
(
Signature of County Employee)
(License Plate No. Received)
(County Name)
(Date Received)
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
COUNTY MUST COMPLETE ACKNOWLEDGEMENT WHEN FORM AND
LICENSE PLATE ARE SURRENDERED TO COUNTY TAG OFFICE
________________________________________________________________________________________________
ORIGINAL: MOTOR VEHICLE DIVISION
1 COPY: RETAINED BY COMPANY/AGENT AND SUBMITTED WITH SUBSEQUENT TITLE/TAG APPLICATION
1 COPY: RETAINED BY COMPANY/AGENT AND SUBMITTED WITH SUBSEQUENT TITLE/TAG APPLICATION
1 COPY: RETAINED BY COMPANYU/AGENT/SURRENDERING LICENSE PLATE
Applicable copies should be distributed and/or retained by company/agent
The Motor Vehicle Division will not make copies of a completed form T -158.
SUBMISSION OF THIS FORM AND LICENSE PLATE DOES NOT CONSTITUTE PROOF THAT AD VALOREM TAXES HAVE BEEN PAID
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