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Signature of Applicant Printed Name of Applicant Date Signed mm/dd/yyyy Relationship to Applicant s if other than Applicant Example agent POA executor of estate etc. SECTION 4 NOTARY Subscribed and sworn before me a Notary Public this day of. Forty-five 45 days have elapsed since the death of the decendent. Distributee 1. Decedent left no widow or widower surving him or her. Reset Form APPLICATION FOR REFUND BUREAU OF MOTOR VEHICLES Finance Department 100 North Senate Avenue Room N440...
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