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This document is a New York State Insurance Identification Card issued by Progressive Casualty Insurance Co for policy number 939683250. It provides details including the effective and expiration dates of the insurance, the names and addresses of the insured individuals, and the vehicle information for a 2009 Honda. The card must be carried in the insured vehicle and is required for production upon demand, with warnings about the legal implications of presenting it without valid insurance coverage.

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Jhonatan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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5 views

gamboa2(1)

This document is a New York State Insurance Identification Card issued by Progressive Casualty Insurance Co for policy number 939683250. It provides details including the effective and expiration dates of the insurance, the names and addresses of the insured individuals, and the vehicle information for a 2009 Honda. The card must be carried in the insured vehicle and is required for production upon demand, with warnings about the legal implications of presenting it without valid insurance coverage.

Uploaded by

Jhonatan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form_SCTNID_CTGRY.

NY02151390_IDCARD

<docindex><index>IDCARD</index></docindex> BDF_AA
NEW YORK STATE INSURANCE IDENTIFICATION CARD
Policy Number
939683250
413 Progressive Casualty Insurance Co
Name & Address of Issuer Progressive Casualty Insurance Co Effective Date Expiration Date Your Agent or Broker:
6300 Wilson Mills Road 12/25/2023 06/25/2024 Campos Ins Agency,Inc
Mayfield Village, Ohio 44143 12:01 a.m. 12:01 a.m. 1-914-328-3046
(Not acceptable to obtain registration
An authorized NEW YORK insurer has issued an Owner's Policy of Liability after 45 days from effective date.) THIS ID CARD MUST BE CARRIED IN THE
Insurance complying with Article 6 (Motor Vehicle Financial Security Act) of Applicable with respect to the INSURED VEHICLE FOR PRODUCTION UPON
the NEW YORK Vehicle and Traffic Law to: following Motor Vehicle: DEMAND
2009 Honda
WARNING: Any person who issues or produces
GAMBOA PRUDENCIO,I Year Make
an ID card knowing that an Owner's Policy of
VALVERDE DOLORES,G,F 5FNYF48519B027800 insurance is not in effect may be committing a
101 GREENWOOD LN Vehicle Identification Number misdemeanor. In addition, a person who
WHITE PLAINS NY 10607
presents an ID card if insurance is not in effect
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI_
may be committing a misdemeanor.
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI_
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI_
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI_
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI_

The name of the registrant and the name of the


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI_
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI_
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI_
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI_

insured must coincide.


OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI_
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI_
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI_
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI_
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI_
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI_
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI_
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFHHGIGJ_DKLLMAJCMHIKOCDENABLCNEBOB_ODNGEAOAKOJBI_

REPLACEMENT VEHICLE NOTATION: DMV WILL


OOEDGFKNCCNAEIOKDOENBENFLCJGLI_LDNLM_OENMHCJOMIMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDEGHCFLGICGBOMKOJBI_
OOEDFDK_CMFGMKA_HKHNAG_MCB_HHEJ_HLOIEOEHLACHLEINFKHM_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI_
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI_
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI_

ONLY PROCESS A VEHICLE CHANGE


OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI_
OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI_
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIOIAJOAGIFHIOB_LKICLHDIN_IGFEOCOJBI_
OOEDGBBGBBMHAJA_FLFNGDNGKCHIKMNBENJCC_FNM_BMNCIKB_DODMOFHFNBDDBACGC_OFHNELNBBHLCAKKLNHFFAEIHDCOJBI_
OOEDDKLBCCKNIBOB_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI_
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI_
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI_
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI_
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI_
(RE-REGISTRATION) USING THE REPLACED
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI_
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_OIJDFBNDBENAAHILHKOEHF_KMKLFCECBOLKNDNEOICBOIGAHENLOMFOFMNDCOJBI_
OOEDFFKLBHBCMG_IHJLGLGFOLKCAGIGC_NMNLNEAGHBGDCA_HKLLICND_MGBMINAGMNNINBAGKEOJANEAFGCNOENDGAGLKOJBI_ VEHICLE'S CURRENT REGISTRATION.
Form 1390 NY (02/15) FS-20

NEW YORK STATE INSURANCE IDENTIFICATION CARD


Policy Number
939683250
413 Progressive Casualty Insurance Co
Name & Address of Issuer Progressive Casualty Insurance Co Effective Date Expiration Date Your Agent or Broker:
6300 Wilson Mills Road 12/25/2023 06/25/2024 Campos Ins Agency,Inc
Mayfield Village, Ohio 44143 12:01 a.m. 12:01 a.m. 1-914-328-3046
(Not acceptable to obtain registration
An authorized NEW YORK insurer has issued an Owner's Policy of Liability after 45 days from effective date.) THIS ID CARD MUST BE CARRIED IN THE
Insurance complying with Article 6 (Motor Vehicle Financial Security Act) of Applicable with respect to the INSURED VEHICLE FOR PRODUCTION UPON
the NEW YORK Vehicle and Traffic Law to: following Motor Vehicle: DEMAND
2009 Honda
WARNING: Any person who issues or produces
GAMBOA PRUDENCIO,I Year Make
an ID card knowing that an Owner's Policy of
VALVERDE DOLORES,G,F 5FNYF48519B027800 insurance is not in effect may be committing a
101 GREENWOOD LN Vehicle Identification Number misdemeanor. In addition, a person who
WHITE PLAINS NY 10607
presents an ID card if insurance is not in effect
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI_
may be committing a misdemeanor.
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI_
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI_
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI_
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI_

The name of the registrant and the name of the


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI_
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI_
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI_
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI_

insured must coincide.


OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI_
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI_
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI_
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI_
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI_
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI_
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI_
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFHHGIGJ_DKLLMAJCMHIKOCDENABLCNEBOB_ODNGEAOAKOJBI_

REPLACEMENT VEHICLE NOTATION: DMV WILL


OOEDGFKNCCNAEIOKDOENBENFLCJGLI_LDNLM_OENMHCJOMIMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDEGHCFLGICGBOMKOJBI_
OOEDFDK_CMFGMKA_HKHNAG_MCB_HHEJ_HLOIEOEHLACHLEINFKHM_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI_
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI_
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI_
OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI_
OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI_
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIOIAJOAGIFHIOB_LKICLHDIN_IGFEOCOJBI_
OOEDGBBGBBMHAJA_FLFNGDNGKCHIKMNBENJCC_FNM_BMNCIKB_DODMOFHFNBDDBACGC_OFHNELNBBHLCAKKLNHFFAEIHDCOJBI_
OOEDDKLBCCKNIBOB_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI_
ONLY PROCESS A VEHICLE CHANGE
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI_
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI_
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI_
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI_
(RE-REGISTRATION) USING THE REPLACED
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI_
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_OIJDFBNDBENAAHILHKOEHF_KMKLFCECBOLKNDNEOICBOIGAHENLOMFOFMNDCOJBI_
OOEDFFKLBHBCMG_IHJLGLGFOLKCAGIGC_NMNLNEAGHBGDCA_HKLLICND_MGBMINAGMNNINBAGKEOJANEAFGCNOENDGAGLKOJBI_ VEHICLE'S CURRENT REGISTRATION.
Form 1390 NY (02/15) FS-20

FAX: Scanable Bar Code


FAX INSTRUCTIONS:
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI

1. The entire page must be faxed.


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI
OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI
2. If submitted to DMV, either the entire page
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFHHGIGJ_DKLLMAJCMHIKOCDENABLCNEBOB_ODNGEAOAKOJBI
or the second ID card and large scanable
bar code will be retained
OOEDGFKNCCNAEIOKDOENBENFLCJGLI_LDNLM_OENMHCJOMIMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDEGHCFLGICGBOMKOJBI
OOEDFDK_CMFGMKA_HKHNAG_MCB_HHEJ_HLOIEOEHLACHLEINFKHM_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI
OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI

3. A faxed ID card must be replaced with a


OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIOIAJOAGIFHIOB_LKICLHDIN_IGFEOCOJBI
OOEDGBBGBBMHAJA_FLFNGDNGKCHIKMNBENJCC_FNM_BMNCIKB_DODMOFHFNBDDBACGC_OFHNELNBBHLCAKKLNHFFAEIHDCOJBI
OOEDDKLBCCKNIBOB_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI
scanable ID card within 14 days of the
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_OIJDFBNDBENAAHILHKOEHF_KMKLFCECBOLKNDNEOICBOIGAHENLOMFOFMNDCOJBI
effective date.
OOEDFFKLBHBCMG_IHJLGLGFOLKCAGIGC_NMNLNEAGHBGDCA_HKLLICND_MGBMINAGMNNINBAGKEOJANEAFGCNOENDGAGLKOJBI

4. DMV will not accept a faxed ID card


without a scanable barcode
Form_SCTNID_CTGRY.NY02151390_IDCARD

<docindex><index>IDCARD</index></docindex> BDF_AA
NEW YORK STATE INSURANCE IDENTIFICATION CARD
Policy Number
939683250
413 Progressive Casualty Insurance Co
Name & Address of Issuer Progressive Casualty Insurance Co Effective Date Expiration Date Your Agent or Broker:
6300 Wilson Mills Road 12/25/2023 06/25/2024 Campos Ins Agency,Inc
Mayfield Village, Ohio 44143 12:01 a.m. 12:01 a.m. 1-914-328-3046
(Not acceptable to obtain registration
An authorized NEW YORK insurer has issued an Owner's Policy of Liability after 45 days from effective date.) THIS ID CARD MUST BE CARRIED IN THE
Insurance complying with Article 6 (Motor Vehicle Financial Security Act) of Applicable with respect to the INSURED VEHICLE FOR PRODUCTION UPON
the NEW YORK Vehicle and Traffic Law to: following Motor Vehicle: DEMAND
2002 Toyot
WARNING: Any person who issues or produces
GAMBOA PRUDENCIO,I Year Make
an ID card knowing that an Owner's Policy of
VALVERDE DOLORES,G,F 4T1BE30K72U532611 insurance is not in effect may be committing a
101 GREENWOOD LN Vehicle Identification Number misdemeanor. In addition, a person who
WHITE PLAINS NY 10607
presents an ID card if insurance is not in effect
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI_
may be committing a misdemeanor.
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI_
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI_
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI_
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI_

The name of the registrant and the name of the


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI_
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI_
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI_
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI_

insured must coincide.


OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI_
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI_
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI_
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI_
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI_
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI_
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI_
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFHHGIGJCAJAGLMJGHFMGHFEODCJHO_IJCJ_NIHHEAOAKOJBI_

REPLACEMENT VEHICLE NOTATION: DMV WILL


OOEDGFKNCHKNEADO_KHEHDNACCDOMAGBL_KHBLEOF_KAGNEMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDEGHCFNGMCGBOMKOJBI_
OOEDFDK_CMFGMKA_HKHNAFAJ_KB_HMIDF_LBHCFLNGCHICIAGALM_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI_
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI_
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI_

ONLY PROCESS A VEHICLE CHANGE


OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI_
OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI_
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIAAANIN_IFHIOBGHEAGNNDLJGLGFEOCOJBI_
OOEDGBBGBFOKMJA_FLNM_FHBCCHJCI_JA_M_HFF_ICCMIGA_LM_IMNFFHFNBLNFAKFAHLBFGDCGCBHLCAMMB_IHLAEIHDCOJBI_
OOEDDKLBCMHMAKMCNKOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI_
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI_
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI_
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI_
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI_
(RE-REGISTRATION) USING THE REPLACED
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI_
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_HOJGFBALJANKMFGLBOEK_GEI_CDOCALAGFOMMKEIOKCLAAEAGMHKACOFMNDCOJBI_
OOEDFFKLBI_OAHGMDOLHMDCLDKCLHMMNDNNGDOGMGABOB_IGJD_LCENDNDCCBMOIFAALLBIODLLOBOHNMNDOBKLFLGAGLKOJBI_ VEHICLE'S CURRENT REGISTRATION.
Form 1390 NY (02/15) FS-20

NEW YORK STATE INSURANCE IDENTIFICATION CARD


Policy Number
939683250
413 Progressive Casualty Insurance Co
Name & Address of Issuer Progressive Casualty Insurance Co Effective Date Expiration Date Your Agent or Broker:
6300 Wilson Mills Road 12/25/2023 06/25/2024 Campos Ins Agency,Inc
Mayfield Village, Ohio 44143 12:01 a.m. 12:01 a.m. 1-914-328-3046
(Not acceptable to obtain registration
An authorized NEW YORK insurer has issued an Owner's Policy of Liability after 45 days from effective date.) THIS ID CARD MUST BE CARRIED IN THE
Insurance complying with Article 6 (Motor Vehicle Financial Security Act) of Applicable with respect to the INSURED VEHICLE FOR PRODUCTION UPON
the NEW YORK Vehicle and Traffic Law to: following Motor Vehicle: DEMAND
2002 Toyot
WARNING: Any person who issues or produces
GAMBOA PRUDENCIO,I Year Make
an ID card knowing that an Owner's Policy of
VALVERDE DOLORES,G,F 4T1BE30K72U532611 insurance is not in effect may be committing a
101 GREENWOOD LN Vehicle Identification Number misdemeanor. In addition, a person who
WHITE PLAINS NY 10607
presents an ID card if insurance is not in effect
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI_
may be committing a misdemeanor.
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI_
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI_
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI_
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI_

The name of the registrant and the name of the


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI_
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI_
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI_
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI_

insured must coincide.


OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI_
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI_
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI_
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI_
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI_
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI_
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI_
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFHHGIGJCAJAGLMJGHFMGHFEODCJHO_IJCJ_NIHHEAOAKOJBI_

REPLACEMENT VEHICLE NOTATION: DMV WILL


OOEDGFKNCHKNEADO_KHEHDNACCDOMAGBL_KHBLEOF_KAGNEMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDEGHCFNGMCGBOMKOJBI_
OOEDFDK_CMFGMKA_HKHNAFAJ_KB_HMIDF_LBHCFLNGCHICIAGALM_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI_
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI_
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI_
OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI_
OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI_
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIAAANIN_IFHIOBGHEAGNNDLJGLGFEOCOJBI_
OOEDGBBGBFOKMJA_FLNM_FHBCCHJCI_JA_M_HFF_ICCMIGA_LM_IMNFFHFNBLNFAKFAHLBFGDCGCBHLCAMMB_IHLAEIHDCOJBI_
OOEDDKLBCMHMAKMCNKOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI_
ONLY PROCESS A VEHICLE CHANGE
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI_
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI_
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI_
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI_
(RE-REGISTRATION) USING THE REPLACED
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI_
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_HOJGFBALJANKMFGLBOEK_GEI_CDOCALAGFOMMKEIOKCLAAEAGMHKACOFMNDCOJBI_
OOEDFFKLBI_OAHGMDOLHMDCLDKCLHMMNDNNGDOGMGABOB_IGJD_LCENDNDCCBMOIFAALLBIODLLOBOHNMNDOBKLFLGAGLKOJBI_ VEHICLE'S CURRENT REGISTRATION.
Form 1390 NY (02/15) FS-20

FAX: Scanable Bar Code


FAX INSTRUCTIONS:
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI

1. The entire page must be faxed.


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI
OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI
2. If submitted to DMV, either the entire page
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFHHGIGJCAJAGLMJGHFMGHFEODCJHO_IJCJ_NIHHEAOAKOJBI
or the second ID card and large scanable
bar code will be retained
OOEDGFKNCHKNEADO_KHEHDNACCDOMAGBL_KHBLEOF_KAGNEMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDEGHCFNGMCGBOMKOJBI
OOEDFDK_CMFGMKA_HKHNAFAJ_KB_HMIDF_LBHCFLNGCHICIAGALM_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI
OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI

3. A faxed ID card must be replaced with a


OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIAAANIN_IFHIOBGHEAGNNDLJGLGFEOCOJBI
OOEDGBBGBFOKMJA_FLNM_FHBCCHJCI_JA_M_HFF_ICCMIGA_LM_IMNFFHFNBLNFAKFAHLBFGDCGCBHLCAMMB_IHLAEIHDCOJBI
OOEDDKLBCMHMAKMCNKOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI
scanable ID card within 14 days of the
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_HOJGFBALJANKMFGLBOEK_GEI_CDOCALAGFOMMKEIOKCLAAEAGMHKACOFMNDCOJBI
effective date.
OOEDFFKLBI_OAHGMDOLHMDCLDKCLHMMNDNNGDOGMGABOB_IGJD_LCENDNDCCBMOIFAALLBIODLLOBOHNMNDOBKLFLGAGLKOJBI

4. DMV will not accept a faxed ID card


without a scanable barcode
Form_SCTNID_CTGRY.NY02151390_IDCARD

<docindex><index>IDCARD</index></docindex> BDF_AA
NEW YORK STATE INSURANCE IDENTIFICATION CARD
Policy Number
939683250
413 Progressive Casualty Insurance Co
Name & Address of Issuer Progressive Casualty Insurance Co Effective Date Expiration Date Your Agent or Broker:
6300 Wilson Mills Road 12/25/2023 06/25/2024 Campos Ins Agency,Inc
Mayfield Village, Ohio 44143 12:01 a.m. 12:01 a.m. 1-914-328-3046
(Not acceptable to obtain registration
An authorized NEW YORK insurer has issued an Owner's Policy of Liability after 45 days from effective date.) THIS ID CARD MUST BE CARRIED IN THE
Insurance complying with Article 6 (Motor Vehicle Financial Security Act) of Applicable with respect to the INSURED VEHICLE FOR PRODUCTION UPON
the NEW YORK Vehicle and Traffic Law to: following Motor Vehicle: DEMAND
2016 Subar
WARNING: Any person who issues or produces
GAMBOA PRUDENCIO,I Year Make
an ID card knowing that an Owner's Policy of
VALVERDE DOLORES,G,F JF2SJADC9GH415590 insurance is not in effect may be committing a
101 GREENWOOD LN Vehicle Identification Number misdemeanor. In addition, a person who
WHITE PLAINS NY 10607
presents an ID card if insurance is not in effect
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI_
may be committing a misdemeanor.
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI_
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI_
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI_
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI_

The name of the registrant and the name of the


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI_
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI_
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI_
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI_

insured must coincide.


OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI_
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI_
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI_
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI_
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI_
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI_
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI_
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFKIOJDACLKLFMAJCJ_NFNBDGEOCAHOECCOFJGNNEAOAKOJBI_

REPLACEMENT VEHICLE NOTATION: DMV WILL


OOEDGFKNBNFGAIODHMBGLFOI_KODFIALAFKMA_ELLNBOIJAMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDE_EGHNEOAGBOMKOJBI_
OOEDFDK_CMFGMKA_HKHNAFAJ_KJCCMDB_HJOGHEAHCBFOCILNI_M_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI_
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI_
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI_

ONLY PROCESS A VEHICLE CHANGE


OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI_
OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI_
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIIGNBHCICFHHOKCIAMJOLDKDN_GFEOCOJBI_
OOEDGBBGBLFDAJCG_HBHBGCMIBFGIMB_HDM_HCDFLDBCFAANJO_OGJBE_HDCFOCMNLDNOGACFLDBCDCGAMHHFMNGBEIHDCOJBI_
OOEDDKLBCNGFILDFDKOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI_
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI_
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI_
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI_
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI_
(RE-REGISTRATION) USING THE REPLACED
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI_
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_OIJBFDCJCGMCMMHOFNFGAGBC_KJFDAIG_HOFNFDINACAAMACJCNKIOIFMNDCOJBI_
OOEDFFKLBGLFIJDCNLEKOFI_OJDDCMNKNFILDLDLHCKOBFILODNLECNFM_GJGKIMAJALHOAADCHEJF_IMDMO_KLFLGAGLKOJBI_ VEHICLE'S CURRENT REGISTRATION.
Form 1390 NY (02/15) FS-20

NEW YORK STATE INSURANCE IDENTIFICATION CARD


Policy Number
939683250
413 Progressive Casualty Insurance Co
Name & Address of Issuer Progressive Casualty Insurance Co Effective Date Expiration Date Your Agent or Broker:
6300 Wilson Mills Road 12/25/2023 06/25/2024 Campos Ins Agency,Inc
Mayfield Village, Ohio 44143 12:01 a.m. 12:01 a.m. 1-914-328-3046
(Not acceptable to obtain registration
An authorized NEW YORK insurer has issued an Owner's Policy of Liability after 45 days from effective date.) THIS ID CARD MUST BE CARRIED IN THE
Insurance complying with Article 6 (Motor Vehicle Financial Security Act) of Applicable with respect to the INSURED VEHICLE FOR PRODUCTION UPON
the NEW YORK Vehicle and Traffic Law to: following Motor Vehicle: DEMAND
2016 Subar
WARNING: Any person who issues or produces
GAMBOA PRUDENCIO,I Year Make
an ID card knowing that an Owner's Policy of
VALVERDE DOLORES,G,F JF2SJADC9GH415590 insurance is not in effect may be committing a
101 GREENWOOD LN Vehicle Identification Number misdemeanor. In addition, a person who
WHITE PLAINS NY 10607
presents an ID card if insurance is not in effect
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI_
may be committing a misdemeanor.
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI_
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI_
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI_
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI_

The name of the registrant and the name of the


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI_
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI_
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI_
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI_

insured must coincide.


OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI_
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI_
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI_
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI_
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI_
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI_
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI_
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFKIOJDACLKLFMAJCJ_NFNBDGEOCAHOECCOFJGNNEAOAKOJBI_

REPLACEMENT VEHICLE NOTATION: DMV WILL


OOEDGFKNBNFGAIODHMBGLFOI_KODFIALAFKMA_ELLNBOIJAMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDE_EGHNEOAGBOMKOJBI_
OOEDFDK_CMFGMKA_HKHNAFAJ_KJCCMDB_HJOGHEAHCBFOCILNI_M_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI_
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI_
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI_
OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI_
OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI_
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIIGNBHCICFHHOKCIAMJOLDKDN_GFEOCOJBI_
OOEDGBBGBLFDAJCG_HBHBGCMIBFGIMB_HDM_HCDFLDBCFAANJO_OGJBE_HDCFOCMNLDNOGACFLDBCDCGAMHHFMNGBEIHDCOJBI_
OOEDDKLBCNGFILDFDKOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI_
ONLY PROCESS A VEHICLE CHANGE
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI_
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI_
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI_
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI_
(RE-REGISTRATION) USING THE REPLACED
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI_
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_OIJBFDCJCGMCMMHOFNFGAGBC_KJFDAIG_HOFNFDINACAAMACJCNKIOIFMNDCOJBI_
OOEDFFKLBGLFIJDCNLEKOFI_OJDDCMNKNFILDLDLHCKOBFILODNLECNFM_GJGKIMAJALHOAADCHEJF_IMDMO_KLFLGAGLKOJBI_ VEHICLE'S CURRENT REGISTRATION.
Form 1390 NY (02/15) FS-20

FAX: Scanable Bar Code


FAX INSTRUCTIONS:
OOEDFJ_LBADDAHNCDM_HLGKACJDBDAJA_FKINFGDACJFCIIDAK_IAMLDBCKJHHDAAIJ_HDDHFJC_BNNDADFF_HELNEFC_COJBI
OOEDGMFNCNBEIOKFNNHM_GMCGCHELMAKNDOADBGIE_BIOIMGLBNIHOIGNMAJIN_IODMLLBGAFHOKKOAEMNBABODLCGJHBCOJBI
OOEDEFCNBFAGAGAHNIHDNEBGHBHMOADMO_NGJNGAOEKMKNIJGNBINDAELDLCAOFM_GBLOJAMGEOIJDCGMFOGNHBINGNKBCOJBI
OOEDGJDOBHDBAIJB_IGMOFKMOCMLHMDA_DHHFCGMNKCKBAINHENM_HCFCCCBBLFAFGF_MLLBE_FCCMNFMC_NLHFNCEB_DCOJBI
OOEDEGI_CIAIAMAJ_HBGJFLCMCOGDIBCNLMGHCFGGMCDGDALELLNHCDFKLAKLDBENBABMHGJDACMCMFFAFKO_NIHAFKHACOJBI

1. The entire page must be faxed.


OOEDEBO_BGGCMODNHNICODADGJ_JCMG_K_OJCIFHOLJFGGMMJCNOJNAFCBGKIDOMAHKHHNBLDHHGJHNOMDBGHNOJLGEOKCOJBI
OOEDECLGJBLCAHBIHLMB_FIILCHM_MFAJ_NFHLFDCGCJCCMM_ELHBADGJFOKAGCMJCKLKLOKGKACJCAMICHNDOBKLFHHLCOJBI
OOEDGJDBBBOHMHBNDIKNDGJCCCDOKIIAM_OMFOGHDIC_HNEODFNOLGEFHOAKNM_EAJOLOEIHEJOLCJF_EFGM_LDNHGMBFCOJBI
OOEDGDOJCDGNECFANLCDOFALKKAICMMBGNHN_KDJ_OCAJCMFLCLNICOEOAHKGHKA_NBFMCODE_MOBFLCMDIN_MLDNGJGJCOJBI
OOEDFHEHCMACMJFG_HLGFDD_JC_MDAMAALOBKLDDGGB_J_IHHFNJ_HBFHFNBBMHAJLN_HDFCDFCKBHBAA_DMHIDA_GDBCKOJBI
OOEDGDOGCNDHMNAKBNINGDDCMCFGHIBAOFMKLDGJFFCKALEMLGJIJGNGJABCNIKIOHMFOCAIG_IMK_IMADO_DLHCIFILACOJBI
OOEDFHOMBOKAAFNOHKNCAGDIOJCHBMBHCLLFHOEK_OCJDOMALAFIDANFCDGJMHGIMBGNHN_KDJANCGM_ICMLNJAANGJCMCOJBI
OOEDE_DDCIDGAJNO_LGCDDINOCDLNA_HFFNHAGEMLDCLIGIJFG_HDCCGD_KJNNBANDKLMCCHDBAIJHCAIAIHDIMM_E_BHCOJBI
OOEDGJCCBIOCA_HOBLKHBGHEIJBCLEJO_FLNOJFHNHCHK_INJ_HMCLFGBAICMBAAIG_DOBLLFINAKJGKILAAJHINDGDFHCOJBI
2. If submitted to DMV, either the entire page
OOEDFE_OJCNLEODCJHMG_FM_GKJGMAJAGLIDO_DOKKCGAGAMJCNMNDLGDIOJCHBMBHCLHMG_EDANCDBOIDCGLLNDGGBIOKOJBI
OOEDGBLOCMMFANNBFNHFOGKLJBLC_ILLLNNCJHFHBCCKBLA_DDDHILGFBBLBHCAINOCFLABFDADBCBNOADAHLOGIKDKILCOJBI
OOEDGJABC_DGEOBLNJAOFGMCGBACLIJCLFOKADGJDBCDGAAAGLFKIOJDACLKLFMAJCJ_NFNBDGEOCAHOECCOFJGNNEAOAKOJBI
or the second ID card and large scanable
bar code will be retained
OOEDGFKNBNFGAIODHMBGLFOI_KODFIALAFKMA_ELLNBOIJAMBGNHN_KDJ_OBCELAOJLHMAOIEMMNBCLDE_EGHNEOAGBOMKOJBI
OOEDFDK_CMFGMKA_HKHNAFAJ_KJCCMDB_HJOGHEAHCBFOCILNI_M_MLDMLLBFGFALFDLIGG_E_DDBGGMMKFL_LIC_GFLNCOJBI
OOEDGDAICLMLMMFA_OBHAFD_NKDCJAOFJ_MCLFGBNAKLEAA_DODM_NDFKLAKCKNIJCJ_NBNFGDCBBHOBAKCLHKNELGJ_ICOJBI
OOEDGNMMBM_GAMKOBOMFBDIKNCOACEFAINIFGLFIOICDBGMIOBBLGMDGDOJCOEHIBFOHOLDMFNILB_NDMJGNDM_IOEK_GKOJBI
OOEDDIMLC_MIILOFDNDAGGJLOKLICMI_DFHILNGGKBBHMHAJAHNNOFHEFC_CLKGMNKCNLHFGGKMDBABAALLBFMAMNDINOCOJBI

3. A faxed ID card must be replaced with a


OOEDGLKGBA_OELHCDKKOAFHCMKNIKIMMNDODLCFFANK_EMAJO_FHHGIGKCBCMGCILLNBJCLHGFGIKJGCAOGCDLAGDGIDACOJBI
OOEDEIALCJGLI_LDNHFBGDCLMJCLHIJCOBIJG_ECKOCIMCM_MALIDANG_KNJCLDIIGNBHCICFHHOKCIAMJOLDKDN_GFEOCOJBI
OOEDGBBGBLFDAJCG_HBHBGCMIBFGIMB_HDM_HCDFLDBCFAANJO_OGJBE_HDCFOCMNLDNOGACFLDBCDCGAMHHFMNGBEIHDCOJBI
OOEDDKLBCNGFILDFDKOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHFENFCOJBI
OOEDFLENCAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIGBCNKOJBI
OOEDEINCJAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBFLDDCOJBI
OOEDGLIAJOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHEOJLBOMFAGNK_KOEHGIBDCOJBI
scanable ID card within 14 days of the
OOEDEHBCKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIFCNDKAOBEHOIBLGLIEHFGKOJBI
OOEDDHFLBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDCAIBAHLI_LFDHFCBDHFAKOJBI
OOEDFDNABOMFAGNK_KOEHEOJLBOMFAGNK_OIJBFDCJCGMCMMHOFNFGAGBC_KJFDAIG_HOFNFDINACAAMACJCNKIOIFMNDCOJBI
effective date.
OOEDFFKLBGLFIJDCNLEKOFI_OJDDCMNKNFILDLDLHCKOBFILODNLECNFM_GJGKIMAJALHOAADCHEJF_IMDMO_KLFLGAGLKOJBI

4. DMV will not accept a faxed ID card


without a scanable barcode

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