Fillable Printable Self Certification For Proof Ofresidency

Self Certification For Proof Ofresidency

OUT-OF-STATE ADDRESS: Motor vehicle documents to an out-of-state address will not be issued,

EXCEPT in the case of: U.S. Armed Forces personnel and employees of federal or state governments or

their families whose workplace is located outside of Pennsylvania,a business located outside of

Pennsylvania with no Pennsylvania office, or a Park Model Trailer permanently located in Pennsylvania.

This form must also be submitted when applying for a Persons with Disability Parking Placard using

Form MV-145A to request issuance to an out-of-state address. If any of these exceptions applies to you,

please check the appropriate box in Section C and include documentation with this application.

r I certify that my workplace is located outside of Pennsylvania and I am employed by, or am an immediate family

member of a person employed by:

r U.S. Armed Forces r Federal Government r Pennsylvania State Government

Person meeting exemption (check one): r Self r Spouse r Dependent Child

Please attach a letter from your employer on their letterhead to document your status, or attach a copy of your current

photo ID issued by your employer. If you are the immediate family member of a person meeting one of the allowable

exceptions, attach documentation for the person entitled to the exception.

r I certify that the business is located outside of Pennsylvania with no Pennsylvania location and this vehicle is

regularly operated in carrying on business within this commonwealth. Please attach documentation showing the

existence of the business in a state other than Pennsylvania, the authorized person’s out-of-state driver’s license and

documentation indicating where the vehicle is being used in Pennsylvania.

r I certify that the vehicle is a Park Model Trailer and is permanently located in Pennsylvania. Please attach a copy

of your out-of-state driver's license or photo identification and documentation of where the Park Model Trailer is located

in Pennsylvania.

A VEHICLE INFORMATION

C CERTIFICATION

B VEHICLE OWNER INFORMATION

Vehicle Identification Number

Current Street Address

City

State

Zip Code

Title Number

Registration Plate Number

Date

Applicant’s Signature

D SIGNATURE

I hereby certify under penalty of law that ALL information is TRUE and CORRECT and that I understand that any

misstatement of fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to

one year (18 Pa.C.S. Section 4904[b]).

Date

Co-Applicant’s Signature

Last Name (or Full Business Name)

Middle Name

First Name

PA DL/Photo ID#

or Bus. ID#

Date of Birth

Co-Applicant Last Name

Middle Name

First Name

PA DL/Photo ID#

Date of Birth

MV-8 (8-16)

SELF CERTIFICATION FOR PROOF OF

RESIDENCY

For Department Use Only

Bureau of Motor Vehicles • PO Box 68293 • Harrisburg, PA 17106-8293

Telephone Number

Visit us at www.dmv.pa.gov or call us at 717-412-5300. TTY callers — please dial 711 to reach us.