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Get Penndot - Self-certification Of Vehicle(s) Owned/operated - Lifesafer

A P.O. Box number may be used in addition to the actual residence address, but cannot be used as the only address. State Zip Code B vehicle information (List all vehicles owned or permitted to operate) Plate # Title # VIN # Year/Make Plate # Title # VIN # Year/Make Plate # Title # VIN # Year/Make Violation occured prior to 10/1/03 C statement of ownership/non-ownership (Check appropriate box and complete statement) C I.

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