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I HEREBY CERTIFY THAT THE REGISTRATION DOCUMENT FOR WHICH I HAVE MADE APPLICATION FOR DUPLICATE THEREOF, ON THE REVERSE SIDE HEREOF, WAS MAILED TO ME BY THE COUNTY TREASURER THROUGH THE UNITED STATES POSTAL SERVICE AND (HAS NOT BEEN RECEIVED BY ME) (WAS DAMAGE IN TRANSIT PRIOR TO THE TIME I RECEIVED THE DOCUMENTS). IF I RECEIVE THE ORIGINAL DOCUMENT I AGREE TO RETURN IT TO THE COUNTY TREASURER NO LATER THAN FIVE DAYS FROM THE DATE I RECEIVE IT. Plate Number(s) DATE: SIGNATURE: FORM MAY BE EMAILED TO: