Free Registration Elibibility Declaration - Michigan


File Size: 53.5 kB
Pages: 1
Date: January 24, 2005
File Format: PDF
State: Michigan
Category: Secretary of State
Author: [email protected]
Word Count: 295 Words, 2,176 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.michigan.gov/documents/eligibility_19165_7.pdf

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REGISTRATION ELIGIBILITY DECLARATION
By signing this form, the purchaser or lessee of this vehicle has informed the seller, before entering into a lease or sale agreement, that he or she is not currently subject to registration denial as required by Section 219 (MCL 257.219) of the Michigan Vehicle Code. The purchaser or lessee certifies that his or her license is not currently suspended or revoked for a third or more alcohol-related conviction or for a fourth or more driving violation during a period of suspension. Finally, the purchaser or lessee certifies that he or she does not currently have pending any charge that, if convicted, would result in said purchaser or lessee being revoked or suspended for having 3 or more alcohol-related convictions or 4 or more violations of driver license suspension/revocation/denial. The vehicle cannot be registered if the driver license of any purchaser or lessee is suspended/revoked for 3 or more alcohol-related convictions, or for 4 or more violations of driver license suspension/revocation/denial. Individuals signing this form who are currently subject to registration denial under Section 219 (MCL 257.219) of the Michigan Vehicle Code and who attempt to purchase, lease, title, or register a motor vehicle are guilty of a misdemeanor punishable by imprisonment of up to 93 days or a fine of up to $100.00, or both. Copies of this form must be provided to all purchasers or lessees at the time of signing. Dealers retain a copy of the signed form in their files. _________|_____________________________________|______________________________________ (Date) (Signature of Purchaser/Lessee) (Printed Name of Purchaser/Lessee) _________|_____________________________________|______________________________________ (Date) (Signature of Purchaser/Lessee) (Printed Name of Purchaser/Lessee) _________|_____________________________________|______________________________________ (Date) (Signature of Purchaser/Lessee) (Printed Name of Purchaser/Lessee) _________|_____________________________________|______________________________________ (Date) (Signature of Seller/Seller's Agent) (Printed Name of Seller/Seller's Agent)