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Fillable Printable Form FS-113 - Certificate of Removal from US and Canada - New York

Fillable Printable Form FS-113 - Certificate of Removal from US and Canada - New York

Form FS-113 - Certificate of Removal from US and Canada - New York

Form FS-113 - Certificate of Removal from US and Canada - New York

CERTIFICATEOFREMOVALOFVEHICLEFROM
UNITEDSTATESANDCANADA
Please prepare this form in duplicate, and present both copies with the vehicle registration. The registration will be returned to you
with one copy of this form.
In accordance with Section 318.1(d) of the Vehicle and Traffic Law, I apply for exemption from the Motor Vehicle Financial Security
Act. I certify that: the liability insurance on the vehicle described above has not been, and will not be, terminated or lapsed prior to
removal; and that the vehicle has already been removed from the United States and Canada for the purpose of international traffic, or
that it will be removed for such purpose before _____________________________.
I agree to notify the Commissioner of Motor Vehicles immediately upon return of the vehicle to the United States or Canada, and to
provide new proof of insurance coverage, together with the vehicle registration.
Approved by (MV Staff Member)
Motor Vehicles Office
Signature of Registrant
Date
FS-113 (7/15)
www.dmv.ny.gov
Name
Number and
Street
City or TownStateZip Code
Vehicle I.D.
Number
YearMakeBody TypePlate No.Sticker No.Expiration Date
Please prepare this form in duplicate, and present both copies with the vehicle registration. The registration will be returned to you
with one copy of this form.
In accordance with Section 318.1(d) of the Vehicle and Traffic Law, I apply for exemption from the Motor Vehicle Financial Security
Act. I certify that: the liability insurance on the vehicle described above has not been, and will not be, terminated or lapsed prior to
removal; and that the vehicle has already been removed from the United States and Canada for the purpose of international traffic, or
that it will be removed for such purpose before _____________________________.
I agree to notify the Commissioner of Motor Vehicles immediately upon return of the vehicle to the United States or Canada, and to
provide new proof of insurance coverage, together with the vehicle registration.
Approved by (MV Staff Member)
Motor Vehicles Office
Signature of Registrant
Date
FS-113 (7/15)
www.dmv.ny.gov
Name
Number and
Street
City or TownStateZip Code
Vehicle I.D.
Number
YearMakeBody TypePlate No.Sticker No.Expiration Date
%
cut along dotted line
...........
%
cut along dotted line
...........
%%
cut along dotted line
...........
CERTIFICATEOFREMOVALOFVEHICLEFROM
UNITEDSTATESANDCANADA
reset/clear
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