Address Change Request {ISD 01}

Completion of this section is requested but not required. (Virginia Code §2.2-3806) INFORMATION FOR THE STATE BOARD OF ELECTIONS Are you a citizen of the United States of America? Do you want to apply to register to vote or change your voter registration address? YES (INITIAL BOX) NO (INITIAL BOX) YES (INITIAL BOX) NO (INITIAL BOX) ADDRESS CHANGE REQUEST Purpose: Instructions: ISD 01 (01/13/2011) Use this form to report a change of address to the Virginia Department of Motor Vehicles. Complete this form and submit it to DMV. You will receive an address card to accompany your current driver's license and new vehicle registration card (if applicable) free of charge. The Virginia Department of Motor Vehicles is able to capture and store three different addresses (residence, mailing, and vehicle registration). It is very important to DMV that we capture your correct address(es). You may also update your records immediately by changing your address online at www.dmvNOW.com. CUSTOMER INFORMATION CUSTOMER BIRTH DATE (mm/dd/yyyy) CUSTOMER NUMBER (as it appears on your driver's license or identification card) FULL LEGAL NAME (last) (first) (middle) ADDRESS CHANGE EFFECTIVE DATE (mm/dd/yyyy) (suffix) REASON FOR ADDRESS CHANGE (check one) Correction (such as a typographical error or new 911 address) Moved NEW RESIDENCE/HOME ADDRESS · Enter the address where you actually live. Do not enter a post office box number. Virginia law requires you to provide this address to DMV. · If you change either your residence/home address or mailing address to a non-Virginia address, your driver's license and/or photo identification (ID) card may be canceled. STREET ADDRESS (no P.O.Box) RESIDENCE LOCATION (city or county in which you live) COUNTRY CITY STATE ZIP CODE TELEPHONE NUMBER ( NEW MAILING ADDRESS ) · The address shown on your driver's license may be either a post office box, business or residence address in Virginia. · If you choose to have a mailing address that is different from your residence address, DMV will send all of your documents to the mailing address. · If you change your residence/home address or mailing address to a non-Virginia address, your driver's license and/or photo identification (ID) card may be canceled. MAILING ADDRESS CITY STATE ZIP CODE COUNTRY VEHICLE REGISTRATION MAILING ADDRESS · Use this section if you own a vehicle that is not located at your residence address and you want DMV to mail the vehicle registration renewal notice to an address different from those recorded above or if you want to notify DMV of a vehicle that is garaged somewhere other than where you live. · If you need to change the address of more than two vehicles, use the additional space on the back of this form VEHICLE 1 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 2 VEHICLE MAKE MAILING ADDRESS COUNTRY TITLE NUMBER CITY GARAGE JURISDICTION (city, county, or town where your vehicle is located) LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) To record additional vehicles, complete the reverse side of this form CERTIFICATION I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation. NAME (print) SIGNATURE DATE (mm/dd/yyyy) DAYTIME TELEPHONE NUMBER ( ) American LegalNet, Inc. www.FormsWorkFlow.com ISD 01 (01/13/2011) ADDITIONAL VEHICLE REGISTRATION MAILING ADDRESS VEHICLE 3 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 4 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 5 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 6 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 7 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 8 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 9 VEHICLE MAKE MAILING ADDRESS COUNTRY VEHICLE 10 VEHICLE MAKE MAILING ADDRESS COUNTRY TITLE NUMBER CITY GARAGE JURISDICTION (city, county, or town where your vehicle is located) LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) TITLE NUMBER CITY LAST 4 DIGITS OF VEHICLE IDENTIFICATION NUMBER (VIN) STATE ZIP CODE GARAGE JURISDICTION (city, county, or town where your vehicle is located) DATE VEHICLE FIRST LOCATED HERE (mm/dd/yyyy) American LegalNet, Inc. www.FormsWorkFlow.com