Form Mv-39 - Notification Of Assignment/correction Of Vehicle Title Upon Death Of Owner

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MV-39 (6-14)
NOTIFICATION OF ASSIGNMENT/CORRECTION
www dmv state pa us
OF VEHICLE TITLE UPON DEATH OF OWNER
For Department Use Only
Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104
Please read ALL information on reverse side before completing form.
A
VEHICLE DESCRIPTION
Title Number
Make of Vehicle
Vehicle Identification Number
Registration Plate Number
B
INFORMANT
Last Name (or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Street Address
City
State
Zip
C
CHECK APPLICABLE BLOCK
o
o
1.
Ownership is being transferred to or by
4.
Ownership is being titled in the estate.
Surviving Spouse - who is co-owner
o
5.
Ownership is being transferred to or by all heirs. List all heirs in Section D.
o
2.
Ownership is being transferred to or by
o
6.
Ownership is being transferred to or by Surviving Spouse or adult
a Joint Tenant with Right of Survivorship.
o
child(ren) to whom vehicle is given by decedent’s will which is not
3.
Ownership is being transferred to or by
to be probated.
Surviving Spouse - who is not co-owner.
D HEIRS -
List name, signature (Part II only), address, relationship and age of all heirs. (In conjunction with Assignment of Title)
I
NAME(S) List heirs signing attached title
ADDRESS
RELATIONSHIP
AGE
I (We) certify that I (We), together with the above person(s) who have executed the assignment block on the title constitute all of the heirs of the
decedent and hereby join in the transfer of ownership of the above described vehicle to the person(s) indicated in the assignment block on the title.
II
ADDRESS
NAME(S) Heirs not signing attached title
SIGNATURE
RELATIONSHIP
AGE
X
X
X
X
E NOTARIZATION
F AFFIDAVIT OF PAYMENT DEBTS
-
Required if Section D and/or F is completed.
SUBSCRIBED AND SWORN
TO BEFORE ME:
MONTH
DAY
YEAR
I hereby state under oath that all debts of the
decedent have been paid.
SIGNATURE OF PERSON ADMINISTERING OATH
S
T
DO NOT NOTARIZE UNLESS
X
A
________________________________________________
SIGNED IN PRESENCE OF NOTARY
Signature of surviving spouse or adult heir
M
P
G PROOF OF DEATH - (Check one)
Original Death Certificate need not be attached if No. 3 below is completed by attending physician or funeral director.
o
o
1.
Original Certificate of Death (must be attached)
2.
Original Certificate of Death from Department of Defense (must be attached)
o
3.
I Certify that _____________________________________________________________________ died on __________________________
Name of Decedent
Date
______________________________________________________ _________________________________________________________
Signature of Attending Physician or Funeral Director
Print Name Exactly As It Appears Above
H VEHICLE INSURANCE INFORMATION
(If vehicle is to be registered)
Insurance Company Name
Policy Effective Date
Policy Number
Policy Expiration Date
I
ACKNOWLEDGMENT AND CERTIFICATION
I/We state that I/we have read and signed this form after its completion, and I/we swear or affirm that the statements made herein are true and correct, and that any statement
made on or pursuant to this form is subject to the penalties of 18 Pa.C.S. Section 4903(a)(2)(relating to false swearing), which shall include punishment of a fine not exceeding
$5,000 or to a term of imprisonment of not more than two years, or both.
In addition, if vehicle is to be registered, I/we acknowledge that I/we may lose my/our operating privilege or vehicle registration for failure to maintain financial responsibility
on the currently registered vehicle for the period of registration.
(
)
Owner Sign Here X _______________________________ Co-Owner Sign Here X _______________________________ Telephone Number___________________
MESSENGER NO. ______________________

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