This government document is issued by General Services for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:xg1tju_bfd4&q=https://www.dgs.pa.gov/Documents/Vehicle%2520Forms/BVM%2520Forms/GSVM-95%2520--%2520final.pdf&sa=U&ved=2ahUKEwiPo9_si-6FAxXU_7sIHTwDBeo4HhAWegQIARAB&usg=AOvVaw3Sil9R0JBOm5nrTKxe0AEi