Application For Certificate Of Title Form printable pdf download

APPLICATION FOR CERTIFICATE OF TITLE

(Type or Print in ink)

Fee of $5.00 for failure to apply for title within 30 days of assignment.

Motor Vehicle

Watercraft

Outboard Motor

Salvage

Check type of application(s):

Memorandum

Duplicate

Replacement

Lien

Certificate of Title Number: _____________________________________________________ Control Number:_____________________________

Applicant’s Printed Name: _____________________________________________________ SSN:________________________________________

Applicant’s Address: _________________________________________________________ Zip:_________________________________________

Lawful owner

Purchase

Lienholder

EVIDENCE OF OWNERSHIP: ________________________________________________________

MCO, MSO, Previous Title No., Registration, etc.

Applicant acquired said motor vehicle by: Purchased

Repo

Auction

Other

From:

Name of previous owner:__________________________________________________________________________

Address of previous owner:________________________________________________________________________

The following is a full statement of all liens on said motor vehicle. If no lien, state “none”. If more than one lien, attach statement of all additional liens.

Lienholder: _____________________________________________ Address: __________________________________________________________

Dealer’s Permit Number: ___________________________________ Vendor’s Number: __________________________________________________

Tax Exempt

Reason:_________________________________________________________________________________________________

Purchase Price $_______________________ Trade in Amount $_______________________ Sales/Use Tax $_______________________

Condition of Vehicle/Watercraft/Outboard Motor (check one only)

Good

Fair

Poor

Wrecked

Sales Credit Amount $______________________

YEAR______________ MAKE_____________________________________ MODEL___________________________________________________

VIN_________________________________________ BODY TYPE________________________ CONVERSION____________________________

ODOMETER CERTIFICATION

Federal and State laws require that you state the mileage in connection with transfer of ownership. Failure to complete or providing false information may result

in fines and/or in imprisonment.

, .





(No Tenths) ACTUAL MILES

I (we) certify to the best of my (our) knowledge that the odometer now reads and is the actual mileage of the vehicle unless one of the following statement is checked:

Excess of Mechanical Limits

Not Actual – Odometer Discrepancy

Buyer’s Signature:_______________________________________________ Address:_____________________________________________________

Seller’s Signature:_______________________________________________ Address:_____________________________________________________

WATERCRAFT________________________________________________ Serial Number/HIN____________________________________________

YEAR_________________ MODEL______________________ LENGTH: __________feet __________ inches

MOTOR_______________ MOTOR SERIAL NUMBER_____________________________________________ HP:___________________________

Warning to transferor and transferee (seller and buyer) You are required by law to state the true selling price.

A false statement is in violation of section 2921.12 of the Ohio Revised Code and is punishable by six months

imprisonment and a fine of up to one thousand dollars or both. All transfers are audited by the Department of

Taxation. The seller and buyer must provide any information requested by the Department of Taxation. The

buyer may be assessed any additional tax found to be due.

State of Ohio :

Applicant’s Signature:_____________________________________________________________________

County of Butler:

Sworn to and subscribed in my presence this___________ day of______________________ , 20_________

Clerk, Deputy Clerk of Court – Notary _____________________________

Application For Certificate Of Title Form

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