Vehicle Application - State Of Louisiana Page 2
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1
2NOTICE:
If a title, license plate, or validation sticker is not received within thirty (30) days after submitting application and fees for
such, contact your nearest Office of Motor Vehicles. Departmental policy provides for the issuance of a free replacement
within sixty (60) days from the date of issuance. Failure to notify this office timely could result in additional fees being
charged.
A.
CONVERSION
Old License Plate Number _____________________
New License Plate Number _____________________
Use _____________________
Use _____________________
Weight _____________________
Weight _____________________
B.
TRANSFER OF PLATE
License plate ___________________ has been removed from a _______________________________________________________
YEAR
MAKE
VIN
and transferred to the vehicle described on the first page of this form. License plate returned is ______________________________
C.
LOST, STOLEN, OR REPLACEMENT
PLATE
STICKER
License Plate Number __________________________________
D.
TITLE CORRECTION
Error: _____________________________________________________________________________________________________
__________________________________________________________________________________________________________
Correct To: ________________________________________________________________________________________________
__________________________________________________________________________________________________________
E.
FARM USE STATEMENT
I do declare that I am a bona fide farmer and am in the business of farming; that the vehicle described on the first page of this form is used
primarily, but not exclusively, in hauling farm produce raised on my farm, from such farm to market and return therefrom; hauling merchandise
to my farm and that this vehicle will not be used to haul another person's farm produce or other products for a fee or compensation. Said farm
is located at:
________________________________________________________________________________________________________________
RFD
Box
City
Parish
Zip
________________________________________________________________________________________________________________
Owner's Signature
F.
DISCLOSURE OF SALVAGED/RECONSTRUCTED/WATER-DAMAGED/HAIL-DAMAGED VEHICLE
In accordance with Louisiana R.S. 32:706.1, the undersigned confirm that the title covering the above referenced vehicle has been branded:
________ Salvaged Vehicle
________ Reconstructed Vehicle
________ Water Damaged: In accordance with Louisiana R.S. 32:774.2, the undersigned confirm that the above referenced vehicle has
sustained water damage to the following extent:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________ Hail-Damaged: In accordance with Louisiana R.S. 32:702(1), the undersigned confirm that the above referenced vehicle has
sustained only cosmetic damage caused by hail, equivalent to seventy-five percent or more of its market value as a result of costs for repairs
to items such as windshields, windows, and rear glass; exterior paint and paint materials; and body damage such as dents.
________________________________________________
___________________________
Signature of Transferor (Seller)
Date
________________________________________________
___________________________
Signature of Transferee (Buyer)
Date
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