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MISSISSIPPI DEPARTMENT OF TRANSPORTATION
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NOTIFICATION OF OWNERSHIP TRANSFER
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Location of Sign
Choose Permit No.:
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County:
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Highway Number:
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City:
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Distance from Right of Way:
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Distance from Intersection:
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Direction from Intersection:
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Route of Nearest Intersecting Highway :
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Side of road:
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LandOwner
First Name:
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Middle Initial:
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Last Name:
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Street Address:
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City:
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State:
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Zip Code:
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Phone Number:
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New Sign Owner Identification
Select Sign Owner:
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Company Name:
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First:
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Middle Initial:
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Last:
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Street Address:
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City:
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State:
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Zip Code:
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Phone Number:
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Email:
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PHYSICAL DESCRIPTION OF SIGN SHALL REMAIN THE SAME AS ON THE DATE OF PURCHASE :
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Current Sign Message:
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The above sign was purchased on _____________________, 20__, from ____________________
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Mail this Notification of Transfer of Outdoor Advertising to :
Mississippi Department of Transportation
Attn: Maintenance Division 75-01
P.O. Box 1850
Jackson, MS 39215-1850
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Please enclose a letter of bill of sale releasing the above sign from the previous
sign owner.
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Signature of New Owner__________________________________
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Date_______________________________
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