760-R-97

AFFIDAVIT FOR PHYSICALLY DISABLED REGISTRATION FEES
IN LIEU OF REGULAR REGISTRATION FEES

 

State of Oklahoma, county of ___________________________________§:
I, the undersigned affiant, being first duty sworn upon my oath, state and certify that I am the owner, or the legal agent of
the owner, of the motor vehicle with the legal description of record as follows, to wit:

___________________________________    __________________________    ______________________________
 Insignia Number Issued by Department of Public Safety                    Serial Number                                                    Tag Number

_______________________________________________ in the name of ____________________________________
Year, Make, Type                                                                                                                         Name of Owner

____________________________________________________. I further state that the above described vehicle has had
 Address
modifications because of the physical disability of the owner or of an individual related to the owner within the second
degree of consanguinity (parent, grandparent, child, grandchild, or sibling by blood) The following is a detailed description
of the modifications to this vehicle:

__________________________________________________________________________________

__________________________________________________________________________________
Detailed list of modifications to vehicle

Under the above provisions, the owner hereby makes application for __________ (year) registration for the above-mentioned vehicle at the handicapped rate.

______________________________________
Affiant                                                                                            

Subscribed and sworn to before me this ________________________ day of _______________ , ___________.

My commission expires _____________________________      _________________________________ , Notary Public.