Form FIV109 "Name / Address Change Request Form for Section Five Plate Types" - Massachusetts

What Is Form FIV109?

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

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Massachusetts Registry of Motor Vehicles;
  • 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 FIV109 by clicking the link below or browse more documents and templates provided by the Massachusetts Registry of Motor Vehicles.

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Download Form FIV109 "Name / Address Change Request Form for Section Five Plate Types" - Massachusetts

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Name / Address Change Request Form
For Section Five Plate Types
Registry of Motor Vehicles · Section Five Division
P.O. Box 55897 · Boston, MA 02205-5897· PHONE: 857-368-8030 · FAX: 857-368-0823
Requirements and Instructions
Use this form to apply for a name/address change. This form can be mailed or faxed to the address listed above.
For sole proprietors using a business name, you must provide the following:
Proof of FID number from the IRS
Amended Certificate of Business from city / town
Amended Dealer’s License from city / town (if applicable)
Photocopy of MA Driver’s License (if applicable)
Photos of exterior business signs, as well as the posted business hours and the building’s interior office
For corporations, you must provide the following:
Article of Amendment from the Secretary of State
Proof of FID number from the IRS
Amended Certificate of Business from city / town (if applicable)
Dealer license from the city or town (if applicable)
Photos of exterior business signs, as well as the posted business hours and the building’s interior office
Note: If you are making a name change and are the holder of a Repair, Farm, or Owner Contractor plate, you must re-title all vehicles associated with
the above plate number. To do this, you must complete an Registration and Title Application (for each vehicle) and submit it with the proper title fee.
Registration Type
Registration Number
A. Business Information
Business Name
Address
Street
City
State
Zip Code
Business Phone Number
Business E-mail Address
Briefly describe the changes you would like to make to your Section 5 Registration:
B. Signature(s)
I, the undersigned, herby certify that all information contained in the application is true and correct to the best of my knowledge and belief.
False statements are punishable by fine, imprisonment or both.
Signature
Date
Signature
Date
FIV109_1119
Name / Address Change Request Form
For Section Five Plate Types
Registry of Motor Vehicles · Section Five Division
P.O. Box 55897 · Boston, MA 02205-5897· PHONE: 857-368-8030 · FAX: 857-368-0823
Requirements and Instructions
Use this form to apply for a name/address change. This form can be mailed or faxed to the address listed above.
For sole proprietors using a business name, you must provide the following:
Proof of FID number from the IRS
Amended Certificate of Business from city / town
Amended Dealer’s License from city / town (if applicable)
Photocopy of MA Driver’s License (if applicable)
Photos of exterior business signs, as well as the posted business hours and the building’s interior office
For corporations, you must provide the following:
Article of Amendment from the Secretary of State
Proof of FID number from the IRS
Amended Certificate of Business from city / town (if applicable)
Dealer license from the city or town (if applicable)
Photos of exterior business signs, as well as the posted business hours and the building’s interior office
Note: If you are making a name change and are the holder of a Repair, Farm, or Owner Contractor plate, you must re-title all vehicles associated with
the above plate number. To do this, you must complete an Registration and Title Application (for each vehicle) and submit it with the proper title fee.
Registration Type
Registration Number
A. Business Information
Business Name
Address
Street
City
State
Zip Code
Business Phone Number
Business E-mail Address
Briefly describe the changes you would like to make to your Section 5 Registration:
B. Signature(s)
I, the undersigned, herby certify that all information contained in the application is true and correct to the best of my knowledge and belief.
False statements are punishable by fine, imprisonment or both.
Signature
Date
Signature
Date
FIV109_1119