Certificate Duplicate Request Form - Carbon County Clerk printable pdf download

Gwynn G. Bartlett, Carbon County Clerk

DATE DUPLICATE TO BE ISSUED________________

PO Box 6, Rawlins, WY 82301

DATE RECEIVED / FILED________________________

Phone: 307.328.2668 / Fax 307.328.2669

FOR CLERKS USE ONLY – Please Initial

SALES TAX_______CSA (LIEN)_________ DOCU PRO (LIEN)_________ NMVTIS___________

CANCELLATION STATUS________

I hereby certify that Wyoming Certificate of Title # ______________________ of Carbon County,

Wyoming, dated________________, was issued to me for the following:

YEAR__________ MAKE_________ MODEL__________ VIN_______________________________

Send Duplicate Title to:

Original Certificate of Title Reads:

__________________________________

Contact name and phone number:_________________________________________________________

Notes:______________________________________________________________________________

and that to the best of my knowledge is not assigned to, nor in the possession of any other person, and

there are no additional liens on the said vehicle other than that shown on the original Certificate of Title.

To my knowledge and belief, the said title has been mutilated, lost or destroyed.

I also understand that once a duplicate title is issued on this request that the original, if found, is

invalid and must be returned to your local County Clerk’s office.

I attach, hereto, the necessary fee of $15.00

ALL OWNERS WHOSE NAMES APPEAR ON THE

TITLE MUST SIGN IN THE PRESENCE OF A NOTARY

Signature of Applicant:___________________________________

Subscribed and sworn to before me this___________ day of _______________ 20_______

Notary Public or County Clerk:_______________________________

My Commission Expires:______________________________

Chapter 2. Article 1., Section 31-2-105 Wyoming Statutes, 1977

No duplicate certificate of title shall be issued before the 11

day after the said application is filed

unless the owner shall deposit with the County Clerk an indemnity bond to the State of Wyoming in an

amount not less than double the valuation of the vehicle as shown upon the County Treasurer’s

certificate of registration for the vehicle, executed by a surety company duly authorized to carry on

business in the State of Wyoming.

Certificate Duplicate Request Form - Carbon County Clerk