Fillable Application Form For Certifcate Of Title For A Leased Motor Vehicle printable pdf download

DMV-1L

West Virginia Department of Transportation

Rev. 03/2012

Division of Motor Vehicles

FOR DMV USE ONLY

Application for Certi cate of Title for a Leased Motor Vehicle

CLASS

TYPE OR PRINT IN BLUE OR BLACK INK

NUMBER

MAKE CHECKS PAYABLE TO DIVISION OF MOTOR VEHICLES

EX P. D ATE

INSTRUCTIONS ARE ON THE REVERSE SIDE OF THIS FORM.

LESSOR’S NAME

NAME OF PURCHASER TO BE WRITTEN PLAINLY AND EXACTLY AS IT IS TO APPEAR ON THE CERTIFICATE OF TITLE

C/O LESSEE’S NAME

LESSOR’S ADDRESS

NUMBER

STREET

CITY/TOWN

COUNTY

STATE

ZIP CODE

VEHICLE DESCRIPTION

Make

Year

V. I. N.

Odometer Reading

Style of Body

Weight

(No Tenths)

Passenger vehicle only

TRUCKS Requested (GVW)

Lease Permit

Base Lease

Term

Tax

Number

Payment

Months

Amount

TRADE IN DESCRIPTION

Make

Year

V. I. N.

WV Title No.

Cash Down or Rebate Amount

5% of Cash Down or Rebate Amount

(cap cost reduction)

REGISTRATION PLATE TRANSFERRED FROM VEHICLE BELOW - SEND COPIES OF BOTH SIDES OF REGISTRATION CARD.

Make

Weight

V. I. N.

Plate No.

LIENS AND ENCUMBRANCES

Name of Lien Holder

Amount

Mailing

Kind of Lien

C/S/C

D/T

S/A

Date

Address

Street

City

State

Zip Code

MOTOR VEHICLE INSURANCE POLICY INFORMATION - INSURANCE MUST BE IN EFFECT WHEN APPLICATION IS RECEIVED.

I hereby state that there is a motor vehicle liability policy in effect on the described vehicle in accordance with the provisions of the West Virginia Motor Vehicle

Laws and certify that the statements made herein are true and correct to the best of my knowledge and belief under penalty of false swearing. West Virginia

Motor Vehicle Law § 17A-9-1: Fraudulent Applications.

Effective date of insurance policy: From

THIS TITLE APPLICATION MUST BE SIGNED BY THE OWNER

Name of Insurance Company

Name of Insurance Agent

PRINT COMPANY NAME

(x)

Insurance Policy Number

National Association Insurance Commissioners (NAIC) Number

OWNER’S SIGNATURE - POWER IF ATTORNEY DOCUMENTS MUST BE

PROVIDED IF NOT SIGNED BY OWNER THEMSELVES.

DEALER CERTIFICATION

I hereby state that there is a motor vehicle liability policy in effect on the described vehicle in accordance with the provisions of the West Virginia Motor Vehicle

Laws and certify that the statements made herein are true and correct to the best of my knowledge and belief under penalty of false swearing. West Virginia

Motor Vehicle Law § 17A-9-1: Fraudulent Applications.

This is to certify that the above described vehicle was acquired from _____________________________________________________________________ on

MONTH ____________________

DAY _________

YEAR ___________ and leased to the above-named lessor on MONTH _______________________

DAY _________

YEAR ___________. The undersigned dealer further certifies that the lease payment, term, and tax are true and correct and that the

Federal Odometer Regulation has been satisfied.

FEDERAL ODOMETER REGULATIONS REQUIRE YOU STATE THE ODOMETER MILEAGE UPON TRANSFER OF OWNERSHIP.

I certify to the best of my knowledge that the odometer reading is _____________________ and reflects the actual mileage unless one of the following is checked:

1.) The mileage stated is in excess of it’s mechanical limits.

2.) The odometer reading is not the actual mileage. WARNING-ODOMETER DISCREPANCY.

Dealer Name

Dealer No.

(x)

Dealer Address

Dealer Signature