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Get CA ADM 399/2 2008-2024

12. DATE 13. SIGNATURE OF APPLICANT X 14. DAYTIME TELEPHONE NO. REPORTING UNIT NO. TYPE LICENSE SUB M FEE CLEARANCE INFO FEE CODES Waiver/County APGDLJTBQSVFTB REFUND AMOUNT Q63Q64NU- 00LVL2- VLF OFFSET REBATE TOTAL REFUND VLF PENALTY OFFSET WAIVER CODE TECHNICIAN 2001 AMT DMV APPROVALS LEgIbLE SIgNATuRE REquIREd SUPERVISOR MANAGER PENALTY ADM 399/2 REV. DMV USE ONLY RECEIVED AND DESTROYED STICKER NO. HERE A Public Service Agency APPLICATION FOR REFUND YEAR WARRANT NO. ACCOUNTING USE ONLY PART 2 Must be submitted to Department of Motor Vehicles P. O. Box 942869 MS A235 Sacramento CA 94269-0001 DATE DMV RECEIVED REFUND REQUEST BUSINESS INDICATOR B I 1. NAME LAST FIRST MI 2. MAILING ADDRESS 3. CITY STATE 4. VIN/HIN LAST 3 CHARACTERS 5. REFUND REGARDING COMPLETE NAME 6. LICENSE PLATE ACCOUNT OR RECEIPT NO. 6a* 7. DATE FEES WERE PAID MM/DD/YYYY 8. OFFICE WHERE FEES WERE PAID 9. WERE FEES PAID BY CREDIT CARD Yes ZIP REGISTRATION OCCUPATIONAL DRIVER MISC. 10. AMOUNT OF CLAIM No 11. A REFUND OF FEES IS BEING REQUESTED BECAUSE I am in the military and not a California resident. Please attach completed and signed Certificate of Nonresident Military Exemption form. Vehicle/vessel left California on/last operated in California on and fees were paid on. DATE sold wrecked stolen on and fees were paid on. VLF Offset Refund Request VLF Increase Other please explain briefly. I certify or declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. DMV USE ONLY RECEIVED AND DESTROYED STICKER NO. HERE A Public Service Agency APPLICATION FOR REFUND YEAR WARRANT NO. ACCOUNTING USE ONLY PART 2 Must be submitted to Department of Motor Vehicles P. O. Box 942869 MS A235 Sacramento CA 94269-0001 DATE DMV RECEIVED REFUND REQUEST BUSINESS INDICATOR B I 1. ACCOUNTING USE ONLY PART 2 Must be submitted to Department of Motor Vehicles P. O. Box 942869 MS A235 Sacramento CA 94269-0001 DATE DMV RECEIVED REFUND REQUEST BUSINESS INDICATOR B I 1. NAME LAST FIRST MI 2. MAILING ADDRESS 3. CITY STATE 4. VIN/HIN LAST 3 CHARACTERS 5. REFUND REGARDING COMPLETE NAME 6. NAME LAST FIRST MI 2. MAILING ADDRESS 3. CITY STATE 4. VIN/HIN LAST 3 CHARACTERS 5. REFUND REGARDING COMPLETE NAME 6. LICENSE PLATE ACCOUNT OR RECEIPT NO. 6a* 7. DATE FEES WERE PAID MM/DD/YYYY 8. OFFICE WHERE FEES WERE PAID 9. LICENSE PLATE ACCOUNT OR RECEIPT NO. 6a* 7. DATE FEES WERE PAID MM/DD/YYYY 8. OFFICE WHERE FEES WERE PAID 9. WERE FEES PAID BY CREDIT CARD Yes ZIP REGISTRATION OCCUPATIONAL DRIVER MISC. 10. AMOUNT OF CLAIM No 11. WERE FEES PAID BY CREDIT CARD Yes ZIP REGISTRATION OCCUPATIONAL DRIVER MISC. 10. AMOUNT OF CLAIM No 11. A REFUND OF FEES IS BEING REQUESTED BECAUSE I am in the military and not a California resident. Please attach completed and signed Certificate of Nonresident Military Exemption form. A REFUND OF FEES IS BEING REQUESTED BECAUSE I am in the military and not a California resident. Please attach completed and signed Certificate of Nonresident Military Exemption form. Vehicle/vessel left California on/last operated in California on and fees were paid on. DATE sold wrecked stolen on and fees were paid on. .

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