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## VEHICLE REGISTRATION INFORMATION CHANGE FORM

This form should be completed if you have any changes in information. This includes name and vehicle changes from the previous year registration. Failure to provide current information could result in suspension of the current parking PLEASE PRINT OR TYPE

Personal Information

Name: ___ Student ID#: ___

Last First

Campus Address:

Building and room number

Home Address: ___ City State Zip

Telephone #:___ Driver License:___ State Vehicle Information

Primary Vehicle

License Plate: _____ State: _____

Handicap #:_____ State: _____

Year: ___ Make: ___ Model: ___ Color: ___

Secondary Vehicle

License Plate: ___ State: ___

Handicap #:_____ State: _____

Year: ___ Make: ___ Model: ___ Color: ___

Owner Information

Name: ___

Last First

Home Address: ___

City State Zip

Permit #: ___

7/21/2011