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2. First Name*
3. Last Name*
5. Email Address*
6. Phone Number*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Proof Of City Of Mount Vernon Residency*
    -- Select One --NYS Issued Drivers LicenseNYS Issued Non-Drivers LicenseUtility Bill (ConEd, Water)Mortgage / Lease
16. Upload Proof Of City Of Mount Vernon Residency*
18. Vehicle Details
20. Vehicle Year*
21. Vehicle Make*
23. Vehicle Model*
24. Vehicle Color
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26. 1. Receive an email copy of this form.
27. Email address

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28. Submit Submit and Print

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