Form Mv-41 - Application For Correction Of Vehicle Record Or Verification Of Vehicle Identification Number

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MV-41 (10-08)
APPLICATION FOR
CORRECTION
PA Department of Transportation
OF VEHICLE RECORD OR
Bureau of Motor Vehicles
Harrisburg, PA 17104-2516
VERIFICATION OF VEHICLE
IDENTIFICATION NUMBER
FOR DEPARTMENT USE ONLY
SEE INFORMATION ON REVERSE
Registration Plate Number
Is lienholder an ELT Participant?
Financial Institution Number
Title Number
YES
NO
CHECK
APPLICABLE BLOCK BELOW
1.
Correction or Verification of Vehicle Identification Number. Complete Sections A, B and F.
2.
Application for State Replacement Vehicle Identification Number Plate/Decal. Complete Sections A, C (MUST be completed by a Police Officer),
and F.
Is lienholder an ELT participant?
3.
Correction of body type, number of axles, or other corrections to the vehicle title or registration data. Complete sections A, D and F. (If the vehicle
has been modified, such as the addition or removal of axles, or you are requesting a change to the manufacturer weight specifications, an
MV-426B must be completed.)
4.
Verification of Gross Vehicle Weight Rating (GVWR) or Gross Combination Weight Rating (GCWR) by Inspection Mechanic Only. Complete
Sections A, E and F.
A
VEHICLE OWNER INFORMATION
PA DL/Photo ID #
Last Name (or Full Business Name)
First Name
Middle Name
Date of Birth
or Bus. ID#
PA DL/Photo ID #
Date of Birth
Co-Owner Last Name
First Name
Middle Name
Current Street Address
City
State
Zip Code
County Code
Please use the “County Codes” listing found on the back of this application and list
the numerical code for the County of your residence.
B CORRECTION OR VERIFICATION OF VEHICLE
C
APPLICATION FOR STATE REPLACEMENT VIN PLATE
IDENTIFICATION NUMBER
Original Vehicle Identification Number (if known)
To be used only to correct typographical error of one digit, transposition
of two digits, or if engine number has been erroneously recorded as the
Reason for Replacement of VIN Plate
VIN OR for the purpose of VIN verification.
Lost
Stolen
Defaced
Never Received
ATTACH TRACING HERE OR HAVE AUTHORIZED NOTARY
PUBLIC EMPLOYED BY A FULL AGENT OR MOTOR VEHICLE
Other (Please Explain) _______________________________________________
DEALER,
OR
INSPECTION
MECHANIC
COMPLETE
THE
VERIFICATION INFORMATION BELOW.
VERIFICATION BY POLICE OFFICER (Local or State Police)
Record Correct VIN
Signature of Police Officer
Badge Number
Signature of Notary Public or Inspection Mechanic DIN/Mechanic #
Department Name
Telephone No.
D VEHICLE DATA THAT REQUIRES CORRECTION - Check only the block(s) and list the information that needs correcting due to an
error in the title application or to a change in the use of the vehicle.
Make of Vehicle
Body Type
Year
Seating Capacity
Correct to:
Correct to:
Correct to:
Correct to:
Odometer - See Instructions on Reverse side
Other
Correct to:
Correct to:
Registered Gross Combination Weight
Registered Gross Vehicle Weight
Unladen Weight
Correct to:
Correct to:
Correct to:
E
VERIFICATION OF WEIGHT RATING
(Inspection Mechanic Only)
GCWR
GVWR
Signature of Inspection Mechanic
Inspection Mechanic Number
No. of Axles
Was additional axle installed?
NOTE: If additional axle was added, MV-426B must be completed.
Yes
No
Correct to:
F
CERTIFICATION -
I(We) hereby certify under penalty of law that all information given on this application is true and correct. (Date must be listed).
Signature of Owner or Authorized Person
Date
MESSENGER NO.
Signature of Co-Owner or Title of Authorized Person
Applicant’s Telephone No.
(
)

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