DMV Notice of Vehicle Donation Release

Donor Information

Name

Address

City

State

ZIP Code

Phone Number

Email

Recipient Organization

Name

Address

City

State

ZIP Code

Charity Registration # (if applicable)

Vehicle Information

Year

Make

Model

VIN (Vehicle Identification Number)

License Plate #

Donation Date

Odometer Reading at Donation

Certification and Release

I hereby certify that I have donated the above-described vehicle to the organization listed above and that, to the best of my knowledge, the information provided is true and correct.

Donor Signature

Date

Recipient Organization Representative Signature

Date