Duplicate Certificate Of Title Application & Affidavit Form - Laramie County Clerk
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1Date Received:____________
Issue Date: _____________
CSR Initials:_____________
Duplicate Certificate of
Title Application & Affidavit
To: Debra K. Lathrop
Laramie County Clerk
P. O. Box 608
Cheyenne, WY. 82003
I hereby make application for a duplicate Wyoming Certificate of Title for the following motor vehicle,
trailer, or mobile home, as described below:
Title number:___________________________ VIN:_______________________________
Make:_________________________________ Year:_______________________________
and to the best of my knowledge and belief there are no, other than the liens shown on the original
certificate of title that is (check one)
lost
mutilated or
destroyed
Furthermore, the title has not been assigned to any other person, nor is it in the possession of any other person.
I authorize the duplicate certificate of title be mailed to:
Name:_______________________________________________________________________
Address:_____________________________________________________________________
City:______________________________State:______________________Zip:____________
I hereby swear or affirm under penalty of perjury that all of the information on this application of
Certificate of Title is true and correct and that I am lawfully applying for a Wyoming Certificate of Title.
Signature of Applicant:___________________________________________________________
Signature of Applicant:___________________________________________________________
Subscribed and sworn to before me, by____________________________________________________
On this____________ day of ______________________, 20______.
Notary Public or Deputy Clerk_________________________________
My Commission Expires:_____________________________________
Seal or Stamp
Fee: Fifteen Dollars ($15.00)
020-022 (R 8/13)
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