Form Mvr-1 - Title Application

MVR-1

North Carolina Division of Motor Vehicles

(Rev. 8/99)

TITLE APPLICATION

VEHICLE SECTION

YEAR

MAKE

BODY STYLE

SERIES MODEL

VEHICLE IDENTIFICATION NUMBER

FUEL TYPE

OWNER SECTION

Owner 1 ID # ____________________ __________________________________________________________________________________________________________________

Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name

Owner 2 ID # ____________________ __________________________________________________________________________________________________________________

Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company Name

Residence Address (Individual) Business Address (Firm)

City and State

Zip Code

Tax County

Mail Address (if different from above)

LIEN SECTION

FIRST LIEN

SECOND LIEN

Date of Lien

ACCOUNT #

Date of Lien

ACCOUNT #

Lienholder ID#

Lienholder Name

Lienholder ID#

Lienholder Name

Address ___________________________________________________________________________________

Address ___________________________________________________________________________________

City __________________________________ State __________ Zip Code__________________________

City _________________________________ State __________ Zip Code___________________________

ODOMETER READING

CHECK Appropriate Block/s

n n

n n

Title Only -- Vehicle Not in Operation

Exchanged Plate No. ____________________

n n

Title and License

n n

Class of License_________________________

Replaced Plate No. ______________________

n n

n n

Plate No.Transferred _____________________

Truck Weight desired ____________________

Expiration Date _________________________

I certify for the motor vehicle described above that I have financial responsibility as required by law.

__________________________________________________________________________________

____________________________________________________

Policy Number

Insurance company authorized in N.C.

Date First Operated in N.C.

State of Last Registration

Passenger Capacity

N.C. Dealer No.

Empty Weight

Combined Gross Weight of Truck or

Truck-Tractor with Trailer

Purchased

Purchased for Use in N.C.

From Whom Purchased (Name and address)

Purchase Date

n n

n n

n n

n n

New

Used

Yes

No

n n

n n

Is This Vehicle Leased?

Yes

No

SALES PRICE

If Yes, Attach Form 330 or Lease Agreement

Equipment #

DISCLOSURE SECTION

All motor vehicle records maintained by the North Carolina Division of Motor Vehicles will remain closed for marketing and solicitation unless the block below is checked.

n n

I (We) would like the personal information contained in this application to be available for disclosure.

APPLICATION MUST BE SIGNED IN INK BY EACH OWNER OR AUTHORIZED REPRESENTATIVE OF FIRMS OR CORPORATIONS.

I (we) am (are) the owner(s) of the vehicle described on this application and request that a North Carolina Certificate of Title be issued. I (we) certify that the information on the

application is correct to the best of my (our) knowledge. The vehicle is subject to the liens named and no others. If a registration plate is issued or transferred, I (we) further certify

that there has not been a registration plate revocation and that liability insurance is in effect on this vehicle on the date of this application as required by the North Carolina

Financial Security Act of 1957.

OWNER’S SIGNATURE_____________________________________________________________________________________________________________________________________

Acknowledged before me this _______________ day of _________________________ My commission expires ___________________________________________________________

(SEAL)

Notary Public ____________________________________________________________________

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