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Get Dpsmv 4219

Of Storage/Repair Facility only Fax number of Storage/Repair Facility only FEES 10. 00 CHECK CASHIER S CHECK OR MONEY ORDER MADE OUT TO LOUISIANA OFFICE OF MOTOR VEHICLES NAME OF STORAGE/REPAIR FACILITY PLEASE PRINT OR TYPE CONTACT PERSON AT STORAGE/REPAIR FACILITY MAILING ADDRESS OF STORAGE/REPAIR FACILITY PHYSICAL ADDRESS OF STORAGE/REPAIR FACILITY CITY STATE ZIP CODE DPSMV 4219 R 06/07 ORIGINAL.

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