Form Mvr-4 - Duplicate Certificate Of Title And Assignment By Registered Owner

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MVR-4 (Rev. 6/98)

North Carolina Division of Motor Vehicles

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Duplicate Certificate of Title and Assignment by Registered Owner

Title No. _______________________

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Application for Duplicate Certificate of Title and/or Removal of Lien

VEHICLE DESCRIPTION

Year ___________ Make __________________ Body Style ___________________ Series Model__________________________

Vehicle Identification Number __________________________________________________ Fuel _________________________

Name of Registered Owner(s) ________________________________________________________________________________

FIRST NAME

MIDDLE NAME

LAST NAME

_________________________________________________________________________________________________________

STREET OR R.F.D.

CITY

STATE

ZIP CODE

COUNTY

Mailing Address ___________________________________________________________________________________________

(IF DIFFERENT FROM ABOVE)

LIEN RECORD AS SHOWN ON ORIGINAL TITLE

First Lien _________________________________________________________________________________________________

DATE

LIENHOLDER

ADDRESS

Second Lien ______________________________________________________________________________________________

DATE

LIENHOLDER

ADDRESS

Third Lien ________________________________________________________________________________________________

DATE

LIENHOLDER

ADDRESS

DISCLOSURE SECTION

In 1997, the North Carolina Legislature passed a bill which allows citizens to protect their personal information contained in the records of the

Division of Motor Vehicles. The law also indicates that effective July 1, 1998, the information may be disclosed for surveys, marketing or solic-

itation if the customer has an opportunity to prohibit disclosure.

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I (We) would like the personal information contained in this application not to be released.

*CHECK APPLICABLE BLOCK

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Application for Duplicate Certificate of Title as Recorded

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Application for Duplicate Certificate of Title and Removal of Lien

If original title was issued subject to a lien and it has been satisfied, lienholder must certify to that effect.

I/we, the registered owner(s) of the above described vehicle, hereby make application for a duplicate certificate of title and certify that

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the original has been: (Check applicable block)

Lost

Never Received

I understand that upon issuance of the duplicate, the original title becomes void and that I am required to return the original

title to the Division of Motor Vehicles immediately should it be found.

Current Odometer Reading

____________________________________________________________________________

Signature(s) of registered owner(s)

Acknowledged before me this ________ day of ____________________ 19____ .

Notary Public ___________________________________________

(SEAL)

My commission expires ___________________________________

AFFIDAVIT OF FIRST LIENHOLDER

I/we, support the application for a duplicate certificate of title covering the above described vehicle and certify that the original title was:

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(CHECK APPLICABLE BLOCK)

Title lost while in my possession; lien has been satisfied

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Lost while in my possession

Never Received

Surrendered to ______________ upon payment of lien in full.

___________________________________________________________________________________

Lienholder’s signature by:

Acknowledged before me this ________ day of ____________________ 19____ .

Notary Public ___________________________________________

(SEAL)

My commission expires ___________________________________

NOTICE:

There is a 15-day mandatory waiting period after an application for duplicate title is received by the Division of Motor Vehicles

before a certificate of title can be issued.

*The duplicate title will be issued subject to such liens as were recorded on the last title and mailed to the first lienholder of record, unless lien

release is submitted.

The lienholder may apply for a duplicate title, without the signature(s) of the registered owner(s), if the original title was lost while in the lienhold-

er’s possession.

When a title, mailed to a lienholder by the Division of Motor Vehicles, is not received, affidavits by the registered owner(s) and lienholder(s) are

required in order to obtain a duplicate title.

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