Form Mv-34 - Change Of Address Affidavit
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MV-34 (Rev. 3/2013)
Change of Address Affidavit
This affidavit certifies by signature and notarization that my/our new address is correctly
printed/typed below.
Personal
Last Name:
Driver License/ID Card No.:
Information
First Name:
Initial:
License/ID Expiration Date:
M
M
-
D
D
-
Y
Y
Y
Y
New or Correct ed
Street Number:
Street Name:
Residence
Address:
Apt. No.: (If applicable) County:
Please do not enter
City:
State:
Zip Code:
a PO Box address in
this section.
New or Corrected
Street Number:
P.O. Box or Street Address:
Mailing Address:
Apt. No.: (If applicable) County:
If different from the
residence address.
City:
State:
Zip Code:
I, _______________________________________________, do solemnly swear or affirm under penalty of false
statement, in accordance with the provisions of Georgia law, that the name, driver’s license and address provided on
this affidavit are true and accurate.
: __________________________________________
Signature
M
M
-
D
D
-
Y
Y
Y
Y
Sworn to and subscribed before me this ___________day of ____________________________, 20______
by _____________________________________________________________
______________________________________________
Notary Public
My commission expires:______________________________________
*This address change may be completed for this customer even if the vehicle purchase is cancelled.
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