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Secretary of State
This space for use by
Request for Transfer of
Secretary of State.
Vehicle Registration License Plates
(Year)
Remittance Agent
Secretary of State
License issued
Vehicle Services Department
501 S. Second St., Rm. 532
Springfield, IL 62756
I/We (transferor) release all interest in the following vehicle registration license plates to the individual below (transferee). I/We
acknowledge that such transfers are allowed only to immediate family members.* The transferee is my/our _____________.
Relationship
Plate Number: _____________________
Specialty Plates Category (if applicable): __________________________
Vehicle to which plates are currently registered:
Make: _________________________ Model: __________________________ Year: ______________
VIN: _______________________________________________________________
Person to whom vehicle registration license plates are to be transfered:
Name:
________________________________________________
Address: ________________________________________________
________________________________________________
Under penalty of perjury, the undersigned hereby affirm that the information set forth above is correct.
Transferor:
Transferee:
__________________________________________
__________________________________________
Name (type or print)
Name (type or print)
__________________________________________
__________________________________________
Signature
Signature
Date: _______________________
Date: _______________________
*Immediate family members include: (a) the transferor's spouse, father, mother, children, brothers, sisters and grandchildren;
(b) the father, mother, brothers and sisters of the transferor's spouse; and (c) the spouse of a child, brother or sister of the
transferor.
Printed by authority of the State of Illinois. February 2008 — 10M — VSD 707