Form Mvt-12-1 - Application For Replacement Title - 2006

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APPLICATION

LABAMA

EPARTMENT OF

EVENUE

MVT-12-1

– T

OTOR

EHICLE

IVISION

ITLE

ECTION

R 6/06

P. O. Box 327699 • Montgomery, AL 36132-7699

Application For Replacement Title

TYPE OR PRINT

V V E E H H I I C C L L E E M M U U S S T T B B E E C C U U R R R R E E N N T T L L Y Y T T I I T T L L E E D D I I N N T T H H E E S S T T A A T T E E O O F F A A L L A A B B A A M M A A

TITLE NUMBER

DEPARTMENT USE ONLY

ONLY

F F O O R R 1 1 9 9 7 7 5 5 O O R R N N E E W W E E R R Y Y E E A A R R M M O O D D E E L L V V E E H H I I C C L L E E S S

Submit $15.00 Application Fee (non-refundable)

NOTE: If Lienholder Appeared On Missing Title, The Lienholder Must Complete This Application.

in certified funds payable to

T T H H I I S S F F O O R R M M M M A A Y Y B B E E D D U U P P L L I I C C A A T T E E D D O O R R A A D D D D I I T T I I O O N N A A L L C C O O P P I I E E S S M M A A Y Y B B E E O O B B T T A A I I N N E E D D F F R R O O M M T T H H E E

Alabama Department of Revenue.

Do not send personal checks or cash.

D D E E P P A A R R T T M M E E N N T T W W E E B B S S I I T T E E A A T T w w w w w w . . a a d d o o r r . . s s t t a a t t e e . . a a l l . . u u s s / / m m o o t t o o r r v v e e h h i i c c l l e e / / m m v v f f o o r r m m s s / / m m v v t t 1 1 2 2 _ _ 1 1 . . p p d d f f

VEHICLE IDENTIFICATION NUMBER

TRANS

YEAR

MAKE

MODEL

BODY TYPE

PREVIOUS ALABAMA TITLE NO.

CODE

MODEL

0 0 2 2

CYLS

NEW

USED

DEMO

DATE OF PURCHASE

NUMBER

COLOR

ODOMETER READING

DEPARTMENT USE ONLY

LIENS

O O W W N N E E R R ( ( S S ) ) N N A A M M E E M M U U S S T T B B E E I I D D E E N N T T I I C C A A L L A A S S A A P P P P E E A A R R E E D D O O N N O O R R I I G G I I N N A A L L T T I I T T L L E E

FELONY OFFENSE FOR FALSE ADDRESS

NAME(S) (Last Name, First, Middle)

D D E E P P A A R R T T M M E E N N T T U U S S E E O O N N L L Y Y

CURRENT MAILING

ADDRESS

CITY

STATE

ZIP

N N E E W W L L I I E E N N S S C C A A N N N N O O T T B B E E R R E E C C O O R R D D E E D D O O N N R R E E P P L L A A C C E E M M E E N N T T T T I I T T L L E E S S

(DO NOT ENTER IF LIEN RELEASED)

NAME

LIEN DATE

ADDRESS

CITY

STATE

ZIP

FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD

(DO NOT ENTER IF LIEN RELEASED)

NAME

LIEN DATE

ADDRESS

CITY

STATE

ZIP

FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD

LOCATOR #

S S P P E E C C I I A A L L M M A A I I L L I I N N G G ( ( I I F F N N O O L L I I E E N N S S L L I I S S T T E E D D H H E E R R E E O O N N ) ) : :

OWNER(S) AUTHORIZATION FOR SPECIAL MAILING

O O W W N N E E R R ( ( S S ) ) M M U U S S T T C C O O M M P P L L E E T T E E S S E E C C T T I I O O N N I I I I N N O O R R D D E E R R T T O O H H A A V V E E T T I I T T L L E E S S P P E E C C I I A A L L M M A A I I L L E E D D

REJECT TO:

I (WE) HEREBY AUTHORIZE MY (OUR) CERTIFICATE OF TITLE TO BE MAILED TO (IF NO LIENS LISTED HEREON):

REASONS:

NAME

EXAMINER #

ADDRESS

ENCL:

CITY

STATE

ZIP

A A P P P P L L I I C C A A T T I I O O N N F F O O R R R R E E P P L L A A C C E E M M E E N N T T O O F F A A l l a a b b a a m m a a T T i i t t l l e e : : Number

(IF KNOWN) Which was:

(Mark ONE)

Lost

Stolen

Mutilated

Illegible

Other (reason)

M M u u t t i i l l a a t t e e d d , , i i l l l l e e g g i i b b l l e e , , o o r r a a l l t t e e r r e e d d t t i i t t l l e e m m u u s s t t b b e e s s u u b b m m i i t t t t e e d d w w i i t t h h t t h h i i s s a a p p p p l l i i c c a a t t i i o o n n . .

C C E E R R T T I I F F I I C C A A T T I I O O N N S S T T A A T T E E M M E E N N T T

I understand that upon issuance of the “Replacement” certificate of title, t t h h e e o o u u t t s s t t a a n n d d i i n n g g c c e e r r t t i i f f i i c c a a t t e e o o f f t t i i t t l l e e i i s s “ “ V V o o i i d d e e d d ” ” and, if found, shall be returned to the Alabama Department of Revenue immediately.

A A S S R R E E Q Q U U I I R R E E D D B B Y Y L L A A W W , , I further understand that the “Replacement” certificate will contain the legend, “ “ T T H H I I S S I I S S A A R R E E P P L L A A C C E E M M E E N N T T C C E E R R T T I I F F I I C C A A T T E E O O F F T T I I T T L L E E A A N N D D M M A A Y Y B B E E S S U U B B J J E E C C T T T T O O T T H H E E R R I I G G H H T T S S O O F F

A A P P E E R R S S O O N N U U N N D D E E R R T T H H E E O O R R I I G G I I N N A A L L C C E E R R T T I I F F I I C C A A T T E E O O F F T T I I T T L L E E . . ” ”

I certify that the above information is true and correct to the best of my knowledge and belief and I am aware that a false statement made on this application, with intent to defraud, is a felony violation under the

A A l l a a b b a a m m a a U U n n i i f f o o r r m m C C e e r r t t i i f f i i c c a a t t e e o o f f T T i i t t l l e e a a n n d d A A n n t t i i t t h h e e f f t t L L a a w w ( ( T T i i t t l l e e L L a a w w ) ) ( ( S S e e c c . . 3 3 2 2 - - 8 8 ) ) . .

Application by Recorded Lienholder

Application by Titled Owner if No Lienholder

Was Recorded on Alabama Title

NAME OF LIENHOLDER — MUST BE TYPED OR PRINTED

SIGNATURE OF OWNER

DATE

SIGNATURE OF AUTHORIZED REPRESENTATIVE

DATE

SIGNATURE OF CO-OWNER

DATE

Release of Lien

DESIGNATED AGENT USE ONLY

The lien recorded on the original certificate of title is hereby released. I

understand that by completing Section G and this release of lien (Section

H), this firm WILL NOT appear on the Replacement title as LIENHOLDER.

D.A. NAME

D.A. NUMBER

SIGNATURE OF AUTHORIZED REPRESENTATIVE

DATE

REMITTANCE ADVICE NUMBER

S S u u b b m m i i t t $ $ 1 1 5 5 . . 0 0 0 0 A A p p p p l l i i c c a a t t i i o o n n F F e e e e ( ( n n o o n n - - r r e e f f u u n n d d a a b b l l e e ) ) i i n n c c e e r r t t i i f f i i e e d d f f u u n n d d s s p p a a y y a a b b l l e e t t o o

I I N N S S T T R R U U C C T T I I O O N N S S F F O O R R C C O O M M P P L L E E T T I I N N G G T T H H I I S S F F O O R R M M A A P P P P E E A A R R O O N N B B A A C C K K

A A l l a a b b a a m m a a D D e e p p a a r r t t m m e e n n t t o o f f R R e e v v e e n n u u e e . . D D o o n n o o t t s s e e n n d d p p e e r r s s o o n n a a l l c c h h e e c c k k s s o o r r c c a a s s h h . .