Form MV680 "Affidavit of Non-domiciliary Resident in Regard to Vehicle Registration Under Title 21, Section 2104, Delaware Code" - Delaware

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DELAWARE DIVISION OF MOTOR VEHICLES
AFFIDAVIT OF NON-DOMICILIARY RESIDENT IN REGARD TO VEHICLE
REGISTRATION
UNDER TITLE 21, SECTION 2104, DELAWARE CODE
Financial and insurance manager portion only needs to be completed when vehicle is sold by a Delaware dealer.)
(Note:
Initials
Financial &
Ins.
Initials
Manager
Owner
Affiant must NOT be a bona fide resident of the State of Delaware.
Affiant must NOT claim domicile in the State of Delaware.
Affiant must have one or more vehicles registered and insured at an address outside of the State of
Delaware and provide proof of same by producing a valid certificate of registration and a valid
certificate of insurance clearly identifying the vehicle(s) by Vehicle Identification Number and license
plate number and identifying the insurance by name of company and policy number.
the
Copies of
Affiant's driver's license, registration certificate and certificate of insurance must
be
attached to this application.
Affiant must furnish address where said vehicle is to be registered, insured and primarily garaged
within the State of Delaware.
Affiant acknowledges and understands that the purpose and intent of said iaw is to enable the Affiant
to register and insure said vehicle in Delaware as the Affiant has a non-domiciliary residence in
Delaware and intends this vehicle for use in relation to that Delaware residence.
Affiant acknowledges and understands that removin· g said vehicle from the address stated above for
the purpose of said vehicle being principally garaged and used in conjunction with a non-Delaware
residence will constitute a violation of Title 18, Chapter 24, of the Delaware Code (Insurance Fraud).
Affiant acknowledges and understands that the penalties for Insurance Fraud under Title 18, Chapter
24, can include fines and assessments up to $10,000 for each violation.
It is the responsibility of the Affiant to notify the Delaware Division of Motor Vehicles and the
Affiant's automobile insurance company of any changes in the above conditions within thirty (30)
calendar days from the date of change. Failure to do so may result in the imposition of penalties as
defined above.
BY INITIALING EACH PARAGRAPH AND SIGNING THIS DOCUMENT, BOTH THE F & I MANAGER AND THE
OWNER ACKNOWLEDGE THAT THEY HAVE FULLY READ AND UNDERSTAND EACH ELEMENT AND ARE IN
FULL COMPLIANCE WITH THE REQUIREMENTS OF THIS AFFIDAVIT. FAILURE TO FULLY COMPLY WITH
THESE REQUIREMENTS OR TO MISREPRESENT THE CONDITIONS OF THIS AFFIDAVIT SHALL RESULT IN
CIVIL AND/OR CRIMINAL PROSECUTION AS STATED ABOVE.
DRIVER'S LICENSE NO. & STATE
NAME OF OWNER (Please type or print)
DE PHONE NUMBER
DATE
SIGNATURE OF OWNER (Affiant)
OUT-OF-STATE PHONE
NUMBER
NAME OF DEALERSHIP
NAME OF F & I MANAGER (Please type or print)
DATE
SIGNATURE OF F & I MANAGER
MV680
Doc No. 45-07-98-06· l
DELAWARE DIVISION OF MOTOR VEHICLES
AFFIDAVIT OF NON-DOMICILIARY RESIDENT IN REGARD TO VEHICLE
REGISTRATION
UNDER TITLE 21, SECTION 2104, DELAWARE CODE
Financial and insurance manager portion only needs to be completed when vehicle is sold by a Delaware dealer.)
(Note:
Initials
Financial &
Ins.
Initials
Manager
Owner
Affiant must NOT be a bona fide resident of the State of Delaware.
Affiant must NOT claim domicile in the State of Delaware.
Affiant must have one or more vehicles registered and insured at an address outside of the State of
Delaware and provide proof of same by producing a valid certificate of registration and a valid
certificate of insurance clearly identifying the vehicle(s) by Vehicle Identification Number and license
plate number and identifying the insurance by name of company and policy number.
the
Copies of
Affiant's driver's license, registration certificate and certificate of insurance must
be
attached to this application.
Affiant must furnish address where said vehicle is to be registered, insured and primarily garaged
within the State of Delaware.
Affiant acknowledges and understands that the purpose and intent of said iaw is to enable the Affiant
to register and insure said vehicle in Delaware as the Affiant has a non-domiciliary residence in
Delaware and intends this vehicle for use in relation to that Delaware residence.
Affiant acknowledges and understands that removin· g said vehicle from the address stated above for
the purpose of said vehicle being principally garaged and used in conjunction with a non-Delaware
residence will constitute a violation of Title 18, Chapter 24, of the Delaware Code (Insurance Fraud).
Affiant acknowledges and understands that the penalties for Insurance Fraud under Title 18, Chapter
24, can include fines and assessments up to $10,000 for each violation.
It is the responsibility of the Affiant to notify the Delaware Division of Motor Vehicles and the
Affiant's automobile insurance company of any changes in the above conditions within thirty (30)
calendar days from the date of change. Failure to do so may result in the imposition of penalties as
defined above.
BY INITIALING EACH PARAGRAPH AND SIGNING THIS DOCUMENT, BOTH THE F & I MANAGER AND THE
OWNER ACKNOWLEDGE THAT THEY HAVE FULLY READ AND UNDERSTAND EACH ELEMENT AND ARE IN
FULL COMPLIANCE WITH THE REQUIREMENTS OF THIS AFFIDAVIT. FAILURE TO FULLY COMPLY WITH
THESE REQUIREMENTS OR TO MISREPRESENT THE CONDITIONS OF THIS AFFIDAVIT SHALL RESULT IN
CIVIL AND/OR CRIMINAL PROSECUTION AS STATED ABOVE.
DRIVER'S LICENSE NO. & STATE
NAME OF OWNER (Please type or print)
DE PHONE NUMBER
DATE
SIGNATURE OF OWNER (Affiant)
OUT-OF-STATE PHONE
NUMBER
NAME OF DEALERSHIP
NAME OF F & I MANAGER (Please type or print)
DATE
SIGNATURE OF F & I MANAGER
MV680
Doc No. 45-07-98-06· l
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Download Form MV680 "Affidavit of Non-domiciliary Resident in Regard to Vehicle Registration Under Title 21, Section 2104, Delaware Code" - Delaware

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