Application Form For Certificate Of Title Or Registration
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1
2APPLICATION FORM:
1300-FM-DCNR0043
Rev. 10/2009
ATV PLATE/SNOWMOBILE DECAL NUMBER
CERTIFICATE OF TITLE
•
ALL-TERRAIN VEHICLE (ATV)
•
OFFICIAL USE ONLY
SNOWMOBILE
•
DUPLICATE
PA DEPT OF CONSERVATION
•
SECURITY INTEREST
AND NATURAL RESOURCES
REGISTRATION
SNOWMOBILE/ATV
•
EXPIRATION STICKER ISSUED: MONTH/YEAR
REGISTRATION UNIT
ALL-TERRAIN VEHICLE (ATV)
•
P.O. BOX 8553
SNOWMOBILE
•
HARRISBURG, PA 17105-8553
RENEWAL
(717) 783-9227
TYPE OR PRINT ALL INFORMATION - ATTACH PROOF OF OWNERSHIP
TAX, REGISTRATION AND TITLE FEES
MAKE OF VEHICLE
SERIAL NUMBER (VIN)
YEAR MFG
A.
1. PURCHASE PRICE
MODEL NAME AND NUMBER
DATE OF PURCHASE
2. LESS TRADE IN
(COMPLETE BLOCK A)
TRADE IN INFORMATION
3. TAXABLE AMOUNT
4. x 6% (.06) SALES TAX
LAST NAME (OR FULL BUSINESS NAME)
FIRST NAME
MIDDLE INITIAL
B.
x 7% .07 ALLEGHENY
OWNER
x 8% .08 PHILA
(SEE REVERSE)
CO-OWNER
5. LESS TAX CREDIT
P.O. BOX NO.
COUNTY
6. SALES TAX DUE
7. APPLICANT'S SALES
STREET
TAX LICENSE NUMBER
8. EXEMPTION CODE
CITY
STATE
ZIP CODE
(SEE REVERE)
9. SECURITY INTEREST
C.
IF NO SECURITY INTEREST, CHECK
FEE
FIRST SECURED PARTY
SECOND SECURED PARTY
10. REGISTRATION FEE
11. TITLE FEE OR
DUPLICATE TITLE FEE
12. GRAND TOTAL
TEMPORARY REGISTRATION NUMBER
DATE ISSUED
DEALER NUMBER
D.
TEMPORARY REGISTRATION IS GOOD FOR 45 DAYS FROM DATE ISSUED
•
IS THERE A DCNR REGISTRATION PLATE DISPLAYED ON YOUR ATV?
ATV
E.
YES
REG. NO.
NO
CLASS I - Max. width 50", max. dry wt. 1,000 lbs.
•
IS THERE A DCNR REGISTRATION DECAL DISPLAYED ON YOUR
SNOWMOBILE?
CLASS II - Width over 50", dry wt. over 1,000 lbs
Y
ES
REG. NO.
NO
SNOWMOBILE
F.
REGISTRATION (regular) - Snowmobile/ATV is used off land owned or leased by owner or operator of snowmobile/ATV.
LIMITED REGISTRATION - Snowmobile/ATV is used only on land owned or leased by owner or operator of snowmobile/ATV.
G.
I (WE) CERTIFY THAT I (WE) HAVE EXAMINED THIS FORM AFTER ITS COMPLETION; AND THAT, IF AN EXEMPTION FROM THE
PAYMENT OF TAX IS CLAIMED, I AM (WE ARE) AUTHORIZED TO CLAIM THIS EXEMPTION. I (WE) FURTHER CERTIFY THAT ALL
STATEMENTS HEREIN ARE TRUE AND CORRECT UNDER PENALTY OF LAW.
OWNER
TELEPHONE NUMBER
X
(
)
OWNER
TELEPHONE NUMBER
X
(
)
SEE REVERSE SIDE
White - Snowmobile-ATV Unit
Yellow - Owner
Pink - Dealer
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