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MVR 40-12-23

9/14

lAbAmA

epArtment of

evenue

otor

ehicle

ivision

p.o. box 327630 • montgomery, Al 36132-7630 • (334) 242-9006

petition for refund of registration fees

erroneously or excessively paid for motor vehicle license

THIS FORM IS TO BE FILED WITH YOUR LICENSE PLATE ISSUING OFFICIAL

Instructions:

A. items one (1) thru twelve (12) below must be completed.

b. if applicable, you must submit with the petition the license plate (and/or decal) for which you are requesting the refund, and a copy of the

motor vehicle registration tag and tax receipt or cab card.

c. in item five (5) below, you must give a detailed explanation as to why you believe you are entitled to a refund. in giving this explanation,

please give information such as duplicate tag number, dates (date vehicle was last driven while owned by petitioner), and to whom vehicle

was traded or sold. the petition will be denied if an insufficient explanation is submitted.

ExamplEs:

a. two decals were bought for the same vehicle by the same owner. one was purchased on february 3, ______ (decal

no. 22-1245) and the second was purchased on february 18, ______ (decal no. 22-7875).

b. in error, i purchased a tag march 15, ______ for a vehicle which had been sold on January 5, ______ (proof of sale

of vehicle should be submitted).

D. the petition must be applied for in the name of the person in whose name the tag receipt or cab card is listed.

e. if the vehicle has been sold, please include a copy of the bill of sale showing the date sold and to whom it was sold.

f. if the vehicle was wrecked and totaled, please send a copy of the accident report or insurance report showing the date wrecked or totaled.

G. if the vehicle has not been in operation, please include an affidavit of non-use giving the last date the vehicle was operated on the roads

of Alabama.

As provided by Sections 40-12-23, 40-12-24 and 40-2A-7, Code of Alabama 1975, you are hereby requested to refund the amount erro-

neously or excessively paid as evidenced by:

1. License Plate No. ____________________________ (plate must be surrendered if applicable).

2. Decal No. __________________________________ (decal(s) must be surrendered if applicable).

3. Vehicle Identification Number (VIN)*: ________________________________________________________________

4. County of Registration: _________________________________________________________.

The facts on which this refund is sought and the reasons why the payment of said amount was erroneously or excessive, are as follows:

5. ______________________________________________________________________________________________________________

______________________________________________________________________________________________________________

I attest that the above and foregoing Statement of Facts are true and correct to the best of my knowledge and I understand that this state-

ment is made under penalties of perjury.

6. Sworn and subscribed before me

7. ____________________________________________________

PETITIONER(S)

this the _____ day of _________________________, _______.

8. ____________________________________________________

YEAR

PETITIONER(S) NAME(S) TYPED OR PRINTED

___________________________________________________

9. ____________________________________________________

SIGNATURE OF NOTARY PUBLIC

ADDRESS

My commission expires: ________________________________

10. ____________________________________________________

CITY

STATE

ZIP

11. ____________________________________________________

TELEPHONE NUMBER

12. ____________________________________________________

EMAIL ADDRESS

*All VINs for 1981 and subsequent year model vehicles that conform to federal anti-theft standards are required to have 17 digits/characters.

Form Mvr 40-12-23 - Petition For Refund Of Registration Fees Erroneously Or Excessively Paid For Motor Vehicle License

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