Fillable Vehicle Application Form printable pdf download

Louisiana Department of Public Safety and Corrections

TO AVOID REJECTION:

Office of Motor Vehicles

ELECTRONIC FUND

Complete all required information

P.O. Box 64886, Baton Rouge, LA 70896-4886

TRANSFER CODE

Date Prepared

Type of Plate

VEHICLE APPLICATION

DEALER CODE

VIN

Make

License No.

Exp. Date

Body

Color

Year

Mileage

Model/Weight

If vehicle is a manufactured home, is it used as a residence?

YES

Name of Owner

Driver's License or EIN

Name of Joint Owner (if applicable)

Driver's License or EIN

Owner's Principal Residence Address (or Business Location if Vehicle is Used for Commercial Purposes)

Are you residing within the corporate limits of municipality?

YES

City

State/Zip

Parish

Are you residing within a special tax district or ward?

YES

If yes, what ward or district?

If lessee, domicile, or renter is indicated, renewal notice should be mailed to (check one):

Domicile Code

Lessee

Mail To

Domicile

Renter

Owner

Lessee, renter, or domicile address

Name

Driver's License or EIN of Lessee or Renter

Street

Trade VIN

Trade License No.

City

State/Zip

Parish

VEHICLE IS SUBJECT TO SECURITY AGREEMENT AS FOLLOWS:

ELECTRONIC LIEN

First Lienholder's Name

Second Lienholder's Name

TRANSFER CODE

Street

City/State/Zip

Date Acquired

Tax Date

Previous Title No.

State

Cost of Vehicle

Less Trade

New

Used

Title Fee

Lic Pen Credit

Handling Fee

Rebate

Tax Value

Mortgage Fee

Tax

Tow Fee

DUPLICATE TITLE AFFIDAVIT (Must be signed by owner and notarized.)

The certificate of title issued to me was

License Fee

*Tax Penalty

Miscellaneous Fee

lost

mutilated

never received

Lic Transfer Fee

*Interest

Total Fees

I make application for a duplicate copy of said certificate and agree to hold the

Commissioner harmless if the previous title is obtained by another person.

License Credit

Vendor's Comp

Total Taxes

License Penalty

Tax Credit

Grand Total

I give the Commissioner permission to mail the title to the address on this

application.

BE SURE TO SIGN AND DATE

Owner(s)'s Signature(s) for Duplicate Title

I do swear or affirm that the information contained in this document is true and

correct to the best of my knowledge.

I have and will maintain, during this registration period, vehicle liability insurance

Witness

Sworn and subscribed before me this ________ day of ____________, _______

(security) required by LRS Title 32:861-865. Failure to maintain as agreed will

be a violation of law which may result in criminal prosecution and/or suspension

of registration privileges.

Notary Public Signature, Printed Name

ID Number

If the vehicle being registered is defined as a commercial motor vehicle by the

Federal Motor Carrier Safety Regulations and/or Federal Hazardous Material

AFFIDAVIT OF NON-POSSESSION OF TITLE BY LIENHOLDER

Regulations, by signature below registrant declares knowledge of those federal

Must be signed by lienholder and notarized.

regulations.

I hereby swear or affirm that title of above described vehicle showing lien in our

favor was

never received

received and surrendered to the owner.

Applicant's Signature

Date

Co-Applicant's Signature

Date

Lienholder's Signature

PROOF OF LIABILITY INSURANCE MUST BE FURNISHED AS

PROVIDED FOR BY LAW BEFORE THIS FILE CAN BE PROCESSED.

Witness

Sworn and subscribed before me this ________ day of ____________, _______

TO AVOID PENALTY AND INTEREST:

File must be submitted within 40 days from the date of purchase. For

manufactured houses (mobile homes), file must be submitted by the 20th of the

month following the month of delivery.

Notary Public Signature, Printed Name

ID Number

RECEIVED/REJECTION DATE(S)

*Tax Penalty: 5% of sales tax due for 30 days or fraction thereof (not to

exceed 25%).

*Interest: 1.25% of sales tax due for 30 days or fraction thereof

(no maximum).

Vehicle Application Form

Related Articles

Related forms

Related Categories