Form Mv-141 - Application For The Replacement Of A Lost, Stolen Or Mutilated I. R. P. License Plate

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Form MV-141 (Rev 4-2013)
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Application for the Replacement of a Lost, Stolen or Mutilated I. R. P. License Plate
- Fee $8.00 -
IRP Account #
Fleet #
Supplement #
IRP License Plate #
Owner Equipment # (OEN)
Vehicle Identification Number (VIN)
Owner’s Legal Name
Vehicle Year
Vehicle Make
Address
Insurance Company’s Name
Policy Number
City, State & Zip
I filed an application in accordance with the laws of the State of Georgia and paid the lawful fee for the
registration of the above described vehicle and was furnished the license plate number shown. The original
license plate has been lost, stolen, or mutilated. I have no knowledge of the location of this tag and now request
a replacement license plate and cab card. I do solemnly swear or affirm under criminal penalty of a felony for
fraudulent use of a false or fictitious name or address or for making a material false statement punishable by
fine up to $5,000 or by imprisonment of up to five (5) years, or both, that the statements contained herein are
true and accurate. I certify that the vehicle described in this application has liability insurance as required.
Owner’s Personal Signature:
Date:
Instructions:
•
Except for the signature, this application must be typed, electronically completed & printed or legibly hand-
printed. The owner must sign this completed application.
•
If the license plate is mutilated, the license plate must accompany this application.
•
Submit the original IRP cab card with this application, unless the original was lost or stolen.
•
A copy of the police report where the original license plate was reported as lost or stolen must accompany
this application.
•
The application, $8.00 check or money order payable to the Department of Revenue, mutilated license plate
& cab card (if applicable) & police report (if applicable) can be mailed or submitted in person as follows:
Mailing Address
In-Person Address*
ATTN: IRP Unit
Dept. of Revenue/Motor Vehicle Division
Dept. of Revenue/Motor Vehicle Division
4125 Welcome All Rd
PO Box 740382
ATLANTA, GA 30349
ATLANTA, GA 30374-0382
*Office Hours: 7:30 a.m. - 4:30 p.m.
Monday thru Friday, excluding state holidays
Telephone: 1-855-406-5221 IRP Fax: (404) 724-7760
E-mail:
commercial.vehicles@dor.ga.gov
From this department’s website,
etax.dor.ga.gov
this application may be electronically completed & printed for
signing & submission by mail or in person.

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