Pitt County Forms Center

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   110 Evans Street Greenville, NC 27835 Telephone: (252) 902-3400

   Registered Motor Vehicle Refund Request Form

4. Citizens may request a refund if their vehicle is sold, registered out of state, or no longer in their possession, and the license plate has been turned in to a North Carolina License Plate Agency.

   To be eligible, you must request the refund within one year of surrendering the plate and provide the following:

   • Proof of plate surrender to the NC DMV (DMV Form FS20)
   • One of the following:

   • A copy of the bill of sale
   • Registration from the new state
   • Other documentation showing ownership transfer, which must also be transferred with the NCDMV

   The refund will be calculated based on the number of full calendar months remaining in the registration period after the plate is surrendered.

   Once the NCDMV refund is processed, please allow 8-10 weeks for check delivery.

   All information is required, and incomplete or inaccurate forms may delay your request.

6. First Name*
7. Last Name*
9. Phone Number*
10. Email Address*
12. License Plate #*
13. Year and Make*
14. Model*
16. Reason for Refund*
18. Refund Address:*
20. Upload Required Documentation*
22. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Electronic Signature*
25. Date*
    Date
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

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