Get IN SF 54479 2013-2023

2. The total reinstatement payment amount due must be included along with the payment coupon below. This form is used to pay required reinstatement fees by mail but the individual does not possess the reinstatement fee payment coupon provided by the Indiana Bureau of Motor Vehicles BMV. 6. If your reinstatement fee payment is made via mail send to the address above. 7. If paying by MasterCard or Visa credit or debit card please make sure your card and payment information is included below and the coupon is signed by the cardholder. Detach and mail coupon with your payment to Bureau of Motor Vehicles PO Box 100 Winchester IN 47394-0100. Printed Name of Individual Owing Fees first middle last Date of Birth mm/dd/yyyy Indiana Driver s License or ID Number Mailing Address number and street City State E-mail Address Telephone Number area code seven digits Payment Type Must include card information below. Visa / MasterCard Credit / Debit Card ZIP Code Total Amount Submitted Personal Check Money Order I hereby authorize the Indiana Bureau of Motor Vehicles to charge the amount below to the credit/debit card number indicated for reinstatement fee for the individual named above Signature of Cardholder Date mm/dd/yyyy Cardholder Name Expiration Date mm/dd/yyyy Amount Credit / Debit Card Number Visa MasterCard. Reset Form Bureau of Motor Vehicles PO Box 100 Winchester IN 47394-0100 REINSTATEMENT FEE SUBMISSION State Form 54479 R2 / 9-13 Approved by State Board of Accounts 2013 INDIANA BUREAU OF MOTOR VEHICLES INSTRUCTIONS 1. Any other reinstatement fee payment amount must be made online at myBMV. com or by phone at 888 692-6841 select option 3. Do not include other documents with this payment. If insurance documents are required by the BMV for reinstatement they must be sent electronically by your insurance provider to the BMV. 4. Reinstatement fees may be paid using check money order credit or debit cards. 5. Please make checks or money orders payable to the Bureau of Motor Vehicles. 8. Do NOT send cash. 9. To check the status of your driver record or credential visit myBMV. com or call 888 692-6841 select option 2. Detach and mail coupon with your payment to Bureau of Motor Vehicles PO Box 100 Winchester IN 47394-0100. Printed Name of Individual Owing Fees first middle last Date of Birth mm/dd/yyyy Indiana Driver s License or ID Number Mailing Address number and street City State E-mail Address Telephone Number area code seven digits Payment Type Must include card information below. Visa / MasterCard Credit / Debit Card ZIP Code Total Amount Submitted Personal Check Money Order I hereby authorize the Indiana Bureau of Motor Vehicles to charge the amount below to the credit/debit card number indicated for reinstatement fee for the individual named above Signature of Cardholder Date mm/dd/yyyy Cardholder Name Expiration Date mm/dd/yyyy Amount Credit / Debit Card Number Visa MasterCard. Any other reinstatement fee payment amount must be made online at myBMV. com or by phone at 888 692-6841 select option 3. Do not include other documents with this payment. If insurance documents are required by the BMV for reinstatement they must be sent electronically by your insurance provider to the BMV. .