Change of Address Notice - Rhode Island

NOTICE:
The LAW requires YOU notify the DIVISION OF MOTOR VEHICLES
within TEN (10) DAYS of any change of address.
LICENSE/ID NUMBER REGISTRATION DISABILITY PLACARD NUMBE R DATE OF BIRTH
REG TYPE PLATE NUMBER MONTH DAY YEAR
FULL NAME
NEW RHOD E IS LA ND
RESIDENCE ADDRESS
NEW MAILING ADDRESS
COMPANY OR CORPORATION
FIRST NAME MIDDLE NAME LAST NAME
PLEASE PRINT CORP. NAME AS IT APPEARS ON REGISTRATION
STREET AND NUMBER
STREET AND NUMBER
CITY/TOWN
CITY/TOWN
ZIP CODE
ZIP CODE
MONTH DAY YEAR
DATE MAILED
SIGNATURE IN FULL (DO NO T PRINT)
I, the undersig ned, declare under penalty of perjury that all statements made on this
application for address change are true and complete to the best of my knowledge
and belief.
ADDITIONAL REGISTRATIONS
REG TYPE PLATE NUMBER
REG TYPE PLATE NUMBER
PERSONAL INFORMATION CONTAINED IN YOUR MOTOR VEHICLE RECORD WILL BE
DISCLOSED ONLY IF THE STATE HAS OBTAINED THE EXPRESS CONSENT OF THE
PERSON TO WHOM SUCH PERSONAL INFORMATION PERTAINS.
DO YOU CONSENT TO SUCH DISCLOSURE?
YES NO
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DIVISION OF MOTOR VEHICLES
600 New London Avenue
Cranston, RI 02920-3024
Attention: ADDRESS CHANGE
MAIL TO:
(where vehicle is kept or stored)
IF REGISTRATION IN NAME OF
(please print)
(if different than residence)
401 – 462 - 4368 (4DMV)
TELEPHONE NUMBER
PLEASE LEAVE A NUMBER WHERE WE CAN CONTACT YOU IF APPLICATION IS ILLEGIBLE OR INCOMPLETE
(required)
OLD RHOD E IS LA ND
RESIDENCE ADDRESS
STREET AND NUMBER
CITY/TOWN ZIP CODE
E-MAIL ADDRESS
CANNOT BE P.O. BOX !
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