Application For Certificate Of Title For Motor Vehicle Form

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GERALD E. FUERST
Cuyahoga County Fiscal Officer
Clerk of Courts
Cuyahoga County, Ohio
(TYPE OR PRINT IN INK) This form available on:
APPLICATION(S) FOR CERTIFICATE OF TITLE TO A MOTOR VEHICLE
CHECK TYPE OF APPLICATION(S) FEE OF $5.00 for failure to apply for title within 30 working days of assignment
days of assignment
Applicant’s Name ___________________________________________________________________SSN/EIN: _______________________
Applicant’s Address ____________________________________________________________________________________________
Hereby declares under penalty of perjury that he/she is the lawful (owner/purchaser/lienholder) of the following described motor vehicle
and hereby makes application(s) for the following:
Vin
Year
Make
Body Type
Model
Mileage
Purchase Price $
Trade in Amount $
Tax Base $
Gross Tax $
Net Tax $
Condition of Vehicle (check only one)
( ) good ( ) fair ( ) poor ( ) wrecked
Tax Exemption Reason
Tax Exemption Number
WARNING: You are required by law to state the true selling price. A false statement is in violation of section 2921.13 of the Ohio
Revised Code and is punishable by six months imprisonment and a fine up to one thousand dollars or both. All transfers are audited
By the Department of Taxation. The seller and buyer must provide any information requested by the Department of Taxation. The buyer
may be assessed any additional tax found to be due.
( ) ORIGINAL CERTIFICATE OF TITLE ( ) MEMORANDUM CERTIFICATE OF TITLE
( ) SALVAGE CERTIFICATE OF TITLE
Evidence of Ownership ______________________________
MCO, Previous title no. Registration etc
Applicant acquired said motor vehicle by (state how acquired) _________________________________________________from
Name of Previous Owner ________________________________________________________________________________
Address of Previous Owner _______________________________________________________________________________
The following is a full statement of all liens on said motor vehicle. If no lien, state “none”. If more than one lien, attach statement
Of all additional liens.
Lienholder ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
Dealer Permit Number: ____________________________ Vendor Number: ____________________________
( ) DUPLICATE CERTIFICATE OF TITLE
Applicant states that certificate of title:
Number ________________________ has been ____________________________; that said motor
(lost,stolen,destroyed)
Vehicle has not been sold or disposed of except as stated below.
The vehicle is in the possession of ____________________________________________________
Residing at _________________________________________________and that if said Certificate
Of Title Is hereby recovered by this applicant he/she will deliver same to the Clerk of Courts for
cancellation.
Is applicant a minor? ( ) yes ( ) no
( ) Do not issue a physical title.
Applicant Signature X _______________________________________X ____________________________________________
Position of applicant
Sworn to and subscribed in my presence by _______________________this ________ day of ____________ 20 __________
X ____________________________________________________
(Clerk, Deputy Clerk of Courts –Notary)
My commission expires _____________________________________________, 20 __________
Reset
COC 251 4/07

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