Form 96-0353 "Plate Credit Refund Request" - Arizona

What Is Form 96-0353?

This is a legal form that was released by the Arizona Department of Transportation - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2017;
  • The latest edition provided by the Arizona Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 96-0353 by clicking the link below or browse more documents and templates provided by the Arizona Department of Transportation.

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Download Form 96-0353 "Plate Credit Refund Request" - Arizona

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PLATE CREDIT REFUND REQUEST
Mail Drop 523M
ADOT-Refund Unit
PO Box 2100
• Please allow 3 to 6 weeks for processing
Phoenix AZ 85001-2100
• Apply online at
www.servicearizona.com
or
azdot.gov
96-0353 R05/17
• by Mail, or Fax: 602-712-7071 or
Clear
• by Email:
ADOT_PFTO_Refunds@azdot.gov
If you have questions call 602-712-8391
License Plate Number
Vehicle Identification Number
Year
Make
Customer Name/Lessee (first, middle, last, suffix)
Date of Birth
AZ Driver License or EIN, or N/A
Address Where Refund Is To Be Mailed *
City
State
Zip
Email
* This will not change your address on your MVD record.
In accordance with Arizona law, you are not eligible for a refund if you register the vehicle in another state.
 I certify that I no longer own this vehicle; it has been (check one, must complete Sold Notice below):
 Sold or Traded-in
 Transferred to another person
 Lease ended and vehicle returned
 Vehicle Totaled, Destroyed, or Stolen- Date of Loss:
.
(Complete the Sold notice with the Name of the Insurance Company)
SOLD NOTICE (must be completed in full)
Buyer/Lessor Name (first, middle, last, suffix)
Date Sold/ Transferred
Buyer/Lessor Street Address
City
State
Zip
You are required to destroy the license plate or turn it in to an MVD office or Authorized Third Party Office.
Personalized or Specialty plates do not have to be disposed of, but the month/year tab must be destroyed.
I request a refund of the remaining credit of eligible fees and taxes for the vehicle. I understand that there is a
$12.00 processing fee required by Arizona law, which will be deducted from any refund I receive.
I also understand that in case of multiple owner/lessees, the refund will be divided and distributed among all
owner/lessees on the record.
Customer Signature
Date
Phone
If you were a lessee of the vehicle, your name must be recorded as lessee on the MVD vehicle record in order to
have the refund issued in your name.
Once you have requested a refund, the plate indicated above will be removed from the vehicle record and will not be
valid until properly re-registered. It is against the law to operate any motor vehicle on the public roads of this state
without proper registration.
Refund Unit Use
TRP Hold TRP Expiration
Logged
Date Trsfd
New Veh Reg’d
Credit Trsfd
Addt’l CR Amount
Misc
Letter E or M Cr Ltr
No CR Trsfd Date Received
Refund Amount
PLATE CREDIT REFUND REQUEST
Mail Drop 523M
ADOT-Refund Unit
PO Box 2100
• Please allow 3 to 6 weeks for processing
Phoenix AZ 85001-2100
• Apply online at
www.servicearizona.com
or
azdot.gov
96-0353 R05/17
• by Mail, or Fax: 602-712-7071 or
Clear
• by Email:
ADOT_PFTO_Refunds@azdot.gov
If you have questions call 602-712-8391
License Plate Number
Vehicle Identification Number
Year
Make
Customer Name/Lessee (first, middle, last, suffix)
Date of Birth
AZ Driver License or EIN, or N/A
Address Where Refund Is To Be Mailed *
City
State
Zip
Email
* This will not change your address on your MVD record.
In accordance with Arizona law, you are not eligible for a refund if you register the vehicle in another state.
 I certify that I no longer own this vehicle; it has been (check one, must complete Sold Notice below):
 Sold or Traded-in
 Transferred to another person
 Lease ended and vehicle returned
 Vehicle Totaled, Destroyed, or Stolen- Date of Loss:
.
(Complete the Sold notice with the Name of the Insurance Company)
SOLD NOTICE (must be completed in full)
Buyer/Lessor Name (first, middle, last, suffix)
Date Sold/ Transferred
Buyer/Lessor Street Address
City
State
Zip
You are required to destroy the license plate or turn it in to an MVD office or Authorized Third Party Office.
Personalized or Specialty plates do not have to be disposed of, but the month/year tab must be destroyed.
I request a refund of the remaining credit of eligible fees and taxes for the vehicle. I understand that there is a
$12.00 processing fee required by Arizona law, which will be deducted from any refund I receive.
I also understand that in case of multiple owner/lessees, the refund will be divided and distributed among all
owner/lessees on the record.
Customer Signature
Date
Phone
If you were a lessee of the vehicle, your name must be recorded as lessee on the MVD vehicle record in order to
have the refund issued in your name.
Once you have requested a refund, the plate indicated above will be removed from the vehicle record and will not be
valid until properly re-registered. It is against the law to operate any motor vehicle on the public roads of this state
without proper registration.
Refund Unit Use
TRP Hold TRP Expiration
Logged
Date Trsfd
New Veh Reg’d
Credit Trsfd
Addt’l CR Amount
Misc
Letter E or M Cr Ltr
No CR Trsfd Date Received
Refund Amount