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Get PA MV-371 2012

TITLE NUMBER CITY FIRST NAME MIDDLE NAME VEHICLE IDENTIFICATION NO MAKE OF VEHICLE INCOME INFORMATION Print or Type all Information Eligibility Information on Reverse PA DL/PHOTO ID# DATE OF BIRTH STATE ZIP PA DL/PHOTO ID# DATE OF BIRTH REGISTRATION PLATE NO Total Gross Income During the Past Calender Year 1. SOCIAL SECURITY, SSI PAYMENTS, RETIREMENT BENEFITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. 2. PENSIONS AND ANNUITIES . . . . . . . . .

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