Form Mv100 - Statement Of Fact

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Statement of Fact
Title and Registration Bureau
P.O. Box 201431, 302 N Roberts, Helena, MT 59620-1431
Phone (406) 444-3661 Fax (406) 444-0116
mvdtitleinfo@mt.gov
The Statement of Fact (form MV100) may be used for the purpose of a:
No interest statement
•
Cancellation of sale statement
•
Letter of consent
•
Relinquishment statement
•
Statement of error
•
No security interest or lien to file statement
•
Request to update customer record residential/mailing address
•
Special mailing authorization (titles will be mailed to out-of-state addresses only)
•
Legal signature statement
•
Letter of explanation
•
One and the same statement*
•
Printed name of person making statement and name of firm or corporation
Year
Make
Title Number
Vehicle/Vessel Identification No:
Statement
* Indicate how name is to be entered on the Title:
Under penalty of law (MCA 45-7-203), I certify that the statements made and information contained on this form are
true and correct to the best of my knowledge, information, and belief; I am the person named on this form; and, if
signing for a business entity or trust, I have full authority to do so.
Signature _____________________________________________________________________ Date ________________________
This is my legal signature
Printed name _______________________________________________________________________________________________
Montana county and state authorities reserve the right to reject any form that has been altered.
MV100 (9/16)
This form is available in alternate formats for people with disabilities.

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