Free 00390.FH11 - Indiana

APPLICATION FOR REGISTRATION OF OFF - ROAD VEHICLE OR SNOWMOBILE
State Form 390 (R9 / 12-04) Approved by the State Board of Accounts, 2004

SECTION B: Name of owner (first, middle, last)
Name of owner (first, middle, last) Address (number and street or Rural Route) City State County T elephone number (include area code) ZIP code

Please read all instructions carefully. Type or print in ink. Complete all sections of the form. One application per vehicle.
Please check appropriate box: ATV Snowmobile
SECTION A: Check box to indicate your request. If vehicle is purchased after December 31, 2003, a copy of the bill of sale must be included for all new and transfer registrations, include VIN number. NEW REGISTRATION: $30.00 3 year registration (Vehicle never registered in Indiana) Date purchased:______________________ TRANSFER REGISTRATION: $30.00 3 year registration (Vehicle previously registered in Indiana,change of ownership) Date purchased:______________________ RENEWAL REGISTRATION: $30.00 3 year registration (To renew existing Indiana registration certificate) Online renewal available at www.IN.gov/dnr REPLACEMENT DECALS: $6.00 Includes 2 decals. DUPLICATE AND/OR UPDATED REGISTRATION: $15.00 (Does not include decals) DEALER REGISTRATION: (For demonstration and testing purposes only) 3 year registration - $30.00 CORRECTED REGISTRATION: (To correct registration information issued in error) Return the entire Certificate of Registration with incorrect items circled and correct information inserted. No fee required. CANCEL REGISTRATION: (Registration must be cancelled within 15 days after the vehicle is dismantled, destroyed, traded-in or sold.) Complete information below and sections B and C on the reverse side. No fee required.
Reason for cancellation Signature of owner Date vehicle dismantled, destroyed, traded-in or sold: Date of signature (month, date, year)

OFFICE USE ONLY

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) SECTION C: Registration Information
Year Type of vehicle

Present Indiana registration number Make of vehicle Model name or number Manufacturer's I.D. number (VIN)

SECTION D: Purchased from: List dealer or individuals information
Name Address (street or Rural Route) City Telephone number (include area code) State ZIP code Date purchased (month, day, year)

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SECTION E: Signature of owner in Section B I certify under the penalty of perjury the above information is true and correct.
Signature (signature must be in ink) Date signed (month, day, year)

PAYMENT METHOD Check No. _________________ Money Order No. __________________
VISA*
Mastercard

Credit Card - Exp. Date ________________ Circle one:
Card number PRINT name as it appears on Credit Card Signature

Return this form to:

Customer Service Center Department of Natural Resources 402 W. Washington St., Rm. W160 Indianapolis, IN 46204 Telephone: (317) 232-4200 NO FAXED COPIES ACCEPTED.
(Continued on the reverse side)

Please do not send cash. Refunds will not be issued. Make check or money order payable to Department of Natural Resources.