Form Fc8-13 - Affidavit And Application For Obtaining Duplicate Certificate Of Title - Fremont County Clerk

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Issue Date: ___________

Affidavit and Application for obtaining

DUPLICATE CERTIFICATE OF TITLE

Fee: Fifteen Dollars ($15.00) NON-REFUNDABLE

Return Application To:

Fremont County Clerk, 450 N. 2

St., Rm 220, Lander WY 82520

I/we hereby, make application for a duplicate Wyoming Certificate of Title for the following motor vehicle,

trailer, watercraft or mobile home, as described below (please print):

Name(s) on Title________________________________________________________Daytime Phone#_____________

Title #:________________ Year:______ Make:__________ VIN/HIN #:_______________________________________

and to the best of my knowledge and belief the said original Certificate of Title has been mutilated, lost, or

destroyed, and that it is not assigned to or in the possession of any other person, and there are no additional

liens on said motor vehicle other than shown on the original Certificate of Title.

I hereby make application for a duplicate Certificate of Title covering the said motor vehicle and authorize the

same to be mailed to:

Name:________________________________________________

Mailing Address:_______________________________________

City:__________________ State:________ Zip:_______

Daytime Phone #_________________

I/we hereby swear or affirm under penalty of perjury that all of the information on this application for Duplicate

Certificate of Title is true and correct and that I/we am/are lawfully applying for a Wyoming Certificate of Title.

I/we understand that once a duplicate title is issued on this request that the original, if found, is invalid and

must be destroyed.

(Note: All owners must sign and have signature notarized.)

SIGNATURE OF OWNER__________________________________________Print Name________________________

NOTARY STATEMENT

___________________________________________________________________appeared before me in the State of

_______________________ County of ____________________________this ______day of ___________, ________.

___________________________________________________

(SEAL)

County Clerk or Notary Public

My Commission Expires:_____________________________

Wyoming Statutes 31-2-105

No duplicate certificate shall be issued before the 11

day after the affidavit is filed unless the owner deposits an indemnity bond to the State of

Wyoming with the County Clerk in an amount of not less than double the value of the vehicle shown upon the registration of the vehicle. The bond shall

be executed by a surety duly authorized to carry on business in Wyoming or by individual sureties qualified as provide by W.S. 1-1-104 and 1-1-105.

FOR OFFICE USE ONLY

PRE-TITLE CHECK LIST

Date application is received_____________

Date duplicate is issued ________________

Deputy’s initials ______________

Liens: Yes

_____ Tyler _____ CSA

_____ Tyler

_______ CSA

_____ Sales Tax Hold File

_____ Hold File & Return Work