Affidavit of Exemption for Executive Order 08-170

 

 

 

I _________________________________________, certify that I reside in one of the counties that

                        (Owner’s Printed Name)

 

qualifies for the exemption of fees as authorized in the above named order.  Therefore, I request

 

an exemption for the following transaction(s): 

 

______  Duplicate or replacement motor vehicle license plate

 

______  Registration certificate

 

______  Title certificate

 

______  Replacement parking placard

 

 

 

 

 

 

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

 

 

 

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Owner’s Signature                                                                                                             Date