Application For Registration Of Motor Vehicle
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COUNTY OF HAWAII
DEPARTMENT OF FINANCE
VEHICLE REGISTRATION & LICENSING DIVISION
101 PAUAHI STREET, SUITE #5
HILO, HAWAII 96720
APPLICATION FOR REGISTRATION OF MOTOR VEHICLE
REGISTRATION EXPIRES
TYPEWRITE OR PRINT IN INK
Make:
Model:
Body Type:
Air Cond. Trans.
Auto
Man
OFFICE USE ONLY
Motive Power:
Gas
Propane
Electric
Diesel
Butane
County Tax
VIN#
State Tax
Weight:
Lbs.
GVW
Lbs.
Year Model:
COLOR TOP OR FRONT
Date Sold New:
COLOR BOTTOM OR REAR
State Registration
Vehicle Inspection Expires:
Beautification
Odometer Reading:
(No Tenths)
Total Tax
1. THE MILEAGE READING REFLECTS THE AMOUNT OF
TITLE NUMBER
MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS.
Plate and/or Emblem
2. THE ODOMETER READING IS NOT THE ACTUAL
MILEAGE. WARNING: ODOMETER DISCREPANCY.
County Fee
OFFICE USE ONLY
Present Lic. No.
State:
PENALTY
ACCEPTED:
County
TITLE
REG.
CAI
B/S
MSO
State
B/L
PERMIT #
Total Penalty
HOLD FOR:
Transfer Fee
TITLE
REG.
CAI
B/S
MSO
CLERK:
Total
DATE ISSUED:
Hawai'i County is an Equal Opportunity Provider and Employer
TYPEWRITE OR PRINT IN INK
REGISTERED OWNER(S):
Name
LAST
FIRST
MI
LAST
FIRST
MI
Mailing Address
STREET OR P.O. BOX ADDRESS
CITY
STATE
ZIP CODE
LIENHOLDER (IF NONE, WRITE "NONE"):
Name
Mailing Address
STREET OR P.O. BOX ADDRESS
CITY
STATE
ZIP CODE
I (we) hereby certify that I am (we are) the owner(s) to the extent indicated hereon of the motor vehicle described by this
application and that the foregoing statement is true to the best of my (our) knowledge and belief.
IF FIRM, PRINT NAME AND TITLE OF AUTHORIZED PERSON
X
SIGNATURE(S) OF REGISTERED OWNER(S) SHOWN ABOVE OR IF FIRM, AUTHORIZED PERSON
To be filled in by
Branch of Service
members of U.S.
Station
military forces.
This application certified true and correct.
If vehicle
purchased new
Name of Dealer
locally, dealer
By
countersign here.
AUTHORIZED SIGNATURE
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