Dl-17 Statement of Non-ownership
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Transcript of Dl-17 Statement of Non-ownership
WARNING: Misstatementoffactisamisdemeanorofthethirddegreepunishablebyafineofupto$2,500.00and/or imprisonmentuptooneyear(18PAC.S.Section4904(b)).
DATESIGNATUREININK
I,___________________________________________________________,herebystatethatI
do not own any Motor Vehicles currently registered in the Commonwealth of Pennsylvania.Icertifythatallinformationgivenonthisstatementistrueandcorrect.IfusingaMessengerService, I hereby authorize the Department to furnish them with my driving record for thepurposeofprocessingthisform.
PLEASEPRINTNAME
ALL InformAtIon must Be CompLeted
If you are a registered voter in pA, would you like us to notify your county voter registration office of this change? ❑ Yes ❑ noIf you are not a registered voter, you may contact your county voter registration office.
DRIVER’SLICENSENUMbER LASTNAME jR/ETC
MIDDLENAMEFIRSTNAME
ZIp CodestAte
neW
street
Address
CItY
CHAnGe or CorreCtIon of Address
Address CHAnGe - A post office Box number may be used in addition to the actual residence address, but cannot be used as the only address.
stAtement of non-oWnersHIp of VeHICLe(s) pLeAse tYpe or prInt In BLue or BLACk Ink ALL InformAtIon
DL-17(2-07)
PADepartmentofTransportation•bureauofDriverLicensingP.O.box68693•Harrisburg,PA17106-8693
DATEOFbIRTH(mustbelisted) TELEPHONENUMbER(8:00a.m.to4:30p.m.)
( )E-MAILADDRESS(ifapplicable)
MonthDayYear