Fillable Printable Change of Address Notice - Rhode Island

Change of Address Notice - Rhode Island

NOTICE:

The LAW requires YOU notify the DIVISION OF MOTOR VEHICLES

within TEN (10) DAYS of any change of address.

LICENSE/ID NUMBER REGISTRATION DISABILITY PLACARD NUMBE R DATE OF BIRTH

REG TYPE PLATE NUMBER MONTH DAY YEAR

FULL NAME

NEW RHOD E IS LA ND

RESIDENCE ADDRESS

NEW MAILING ADDRESS

COMPANY OR CORPORATION

FIRST NAME MIDDLE NAME LAST NAME

PLEASE PRINT CORP. NAME AS IT APPEARS ON REGISTRATION

STREET AND NUMBER

CITY/TOWN

ZIP CODE

MONTH DAY YEAR

DATE MAILED

SIGNATURE IN FULL (DO NO T PRINT)

I, the undersig ned, declare under penalty of perjury that all statements made on this

application for address change are true and complete to the best of my knowledge

and belief.

ADDITIONAL REGISTRATIONS

REG TYPE PLATE NUMBER

PERSONAL INFORMATION CONTAINED IN YOUR MOTOR VEHICLE RECORD WILL BE

DISCLOSED ONLY IF THE STATE HAS OBTAINED THE EXPRESS CONSENT OF THE

PERSON TO WHOM SUCH PERSONAL INFORMATION PERTAINS.

DO YOU CONSENT TO SUCH DISCLOSURE?

YES NO

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

DIVISION OF MOTOR VEHICLES

600 New London Avenue

Cranston, RI 02920-3024

Attention: ADDRESS CHANGE

MAIL TO:

(where vehicle is kept or stored)

IF REGISTRATION IN NAME OF

(please print)

(if different than residence)

401 – 462 - 4368 (4DMV)

TELEPHONE NUMBER

PLEASE LEAVE A NUMBER WHERE WE CAN CONTACT YOU IF APPLICATION IS ILLEGIBLE OR INCOMPLETE

(required)

OLD RHOD E IS LA ND

RESIDENCE ADDRESS

STREET AND NUMBER

CITY/TOWN ZIP CODE

E-MAIL ADDRESS

CANNOT BE P.O. BOX !