Form Vp012 - Application For Duplicate Nevada Certificate Of Title Page 2
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1
2APPLICATION FOR DUPLICATE NEVADA CERTIFICATE OF TITLE
Please Print or Type
Vehicle Identification Number
Year
Make
Model
Nevada License Plate Number ___________________________________
Registered Owner(s)/ Lessee Name(s) – (as listed on latest certificate of title). If more than two owners, complete and
attach an additional Duplicate Title form.
Full Legal Name
First
Middle
Last
Nevada Driver’s License, Identification Card Number, Date of Birth, or FEIN for businesses
Physical Address
Address
City
State
Zip Code
Mailing Address
Address
City
State
Zip Code
Full Legal Name
First
Middle
Last
Nevada Driver’s License, Identification Card Number, Date of Birth, or FEIN for businesses
Physical Address
Address
City
State
Zip Code
Mailing Address
Address
City
State
Zip Code
Legal Owner – (as listed on latest certificate of title if applicable)
Lienholder Name
NV Driver’s License, ID Card Number, Date of Birth, NV ELT # or FEIN for businesses
Address
Address
City
State
Zip Code
Lessor Name
NV Driver’s License, ID Card Number, Date of Birth, or FEIN for businesses
Address
Address
City
State
Zip Code
Complete if certificate of title is to be mailed to an address other than the address listed above. If requested by a
third party, other than a licensed Nevada Dealer, a notarized letter of authorization must be attached.
Requested By
Address
Address
City
State
Zip Code
CERTIFICATION
I hereby declare under penalty of perjury that the foregoing is true and correct. I certify that I am the legal owner of the
described vehicle and the original Certificate of Title has been:
Lost
Stolen
Mutilated
Other
Please Explain
State of Nevada, County of: __________________________
By:
Date
Signature of person making statement. If signing for a business, include company stamp or print the company name.
Address
Address
City
State
Zip Code
_____________
This instrument was acknowledged before me on
Date
__________________________________________
Notary Public or Authorized Nevada DMV Representative
VP012 (Rev 2015)
Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once it is signed.
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