Form Rv-F1310401 Certification Of Ownership printable pdf download

TENNESSEE DEPARTMENT OF REVENUE

CERTIFICATION OF OWNERSHIP

You must read the following statement prior to completing this form.

This form is required only if the applicant is seeking title to a vehicle (1) with a fair market value (FMV) of $3,000 or

less or a vehicle at least 30 years old [regardless of FMV], and (2) the applicant is not able to provide other proper

documentation to obtain a title.

Approval of this application and issuance of a title does not relieve the applicant from any past or future litigation

concerning the vehicle. Any person fraudulently using a false or fictitious name on any application for registration of a

vehicle or certificate of title, knowingly concealing a material fact, or otherwise committing fraud on any such

application shall, upon conviction, be punished by the penalty prescribed under the Sentencing Reform Acts of 1989.

State of Tennessee, County of _____________________________

I, _____________________________________________ certify that I am the owner of the vehicle described herein:

(Print or Type Name)

Make _______________ Year Model __________ Vehicle Identification Number _____________________________

Model ___________________ Body Type _________________ Mobile Home Length and Width ________________

Motorcycle Engine Number _____________________________ and under penalty of perjury, state that:

(1) The vehicle was acquired on the ____ day of _____________________ from ___________________________

(Month/Year)

(Former Owner)

whose address is _______________________________________________________________________________

(Street)

(City)

(State)

(Zip)

(Telephone Number)

for $ ____________. This vehicle is subject to the following lien __________________________________________

(Price)

(Lienholder)

______________________________________________________________________________________________

(Street)

(City)

(State)

(Zip)

(Telephone Number)

I certify the above described vehicle is free and clear of all liens except those identified herein and will guarantee title

to any future owner. I also certify the fair market value of the above described vehicle is less than or equal to $3,000

or the above vehicle is at least 30 years old.

(2) Applicant cannot furnish proper documents for the following reason(s): _________________________________

______________________________________________________________________________________________

(3) If the vehicle is less than 30 years old, and the purchase price was more than $3,000, but the fair market value is

now $3,000 or less, I certify the market value is $3,000 or less for the following reason(s): ______________________

______________________________________________________________________________________________

Under penalties of perjury, I hereby certify this information is correct to the best of my knowledge.

________________________________________

__________________________________________

(Signature of Certifier)

(Telephone Number)

RV-F1310401 (Rev. 5-08)

Form Rv-F1310401 Certification Of Ownership

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