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COUNTY OF HAWAII <br /> DEPARTMENT OF FINANCE <br /> VEHICLE REGISTRATION&LICENSING DIVISION <br /> 101 PAUAHI STREET,SUITE#5 <br /> HILO,HAWAII 9672( <br /> APPLICATION FOR REGISTRATION OF MOTOR VEHICLE <br /> TYPEWRITE OR PRINT IN INK REGISTRATION EXPIRES <br /> Make: Model: Body Type: <br /> ElAir Cond. Trans. El AutF-j Man <br /> Motive Power: 0Sas ❑DieselDButane El Propane Electric OFFICE USE ONLY <br /> VIN# County Tax <br /> Weight: Lbs. GVW Lbs. Year Model: State Tax <br /> COLOR TOP OR FRONT I COLOR BOTTOM OR REAR Date Sold New: <br /> State Registration <br /> Vehicle Inspection Expires. <br /> Odometer Reading: (No Tenths) Beautification <br /> vTHE MILEAGE READING REFLECTS THE AMOUNT OF TITLE NUMBER Total Tax <br /> MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS. <br /> ❑2.THE ODOMETER READING IS NOT THE ACTUAL Plate and/or Emblem <br /> MILEAGE.WARNING:ODOMETER DISCREPANCY. <br /> OFFICE USE ONLY County Fee <br /> Present Lic.No. State: <br /> ACCEPTED: PENALTY <br /> TITLE REG. CAI B/S MSO County <br /> B/L PERMIT# State <br /> HOLD FOR: Total Penalty <br /> TITLE REG. CAI B/S MSO Transfer Fee <br /> DATE ISSUED: CLERK: Total <br /> Hawari County Is an Equal Opportunity Provider and Employer <br /> TYPEWRITE OR PRINT IN INK <br /> REGISTERED OWNER(S): <br /> Name <br /> LAST FIRST MI <br /> LAST FIRST MI <br /> Mailing Address <br /> STREET OR P.O.BOX ADDRESS <br /> CITY STATE ZIP CODE <br /> LIENHOLDER(IF NONE,WRITE"Ni <br /> Name <br /> Mailing Address <br /> STREET OR P.O.BOX ADDRESS <br /> CITY STATE ZIP CODE <br /> I(we)hereby certify that I am(we are)the owner(s)to the extent indicated hereon of the motor vehicle described by this <br /> application and that the foregoing statement is true to the best of my(our)knowledge and belief. <br /> IF FIRM,PRINT NAME AND TITLE OF AUTHORIZED PERSON <br /> X <br /> SIGNATURE(S)OF REGISTERED OWNER(S)SHOWN ABOVE OR IF FIRM,AUTHORIZED PERSON <br /> To be filled in by Branch of Service <br /> members of U.S. ► <br /> military forces. Station <br /> If vehicle This application certified true and correct. <br /> purchased new ► Name of Dealer <br /> locally,dealer By <br /> countersign here. AUTHORIZED SIGNATURE <br />