Vermont Registration Tax And Title Application

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VERMONT REGISTRATION, TAX AND TITLE APPLICATION
TYPE OR USE INK
Agency of Transportation, Department of Motor Vehicles, 120 State St., Montpelier, VT 05603-0001
DEPARTMENT USE ONLY – DO NOT WRITE IN SHADED AREA
REG TYPE
INDEX
EXP
#
Year Month
o TEMP PLATE DATE
OLD #1
490
o
o
o
231
225
452
________
________
________
/
C or
PLATE TYPE
o
N
P
o
o IN LIEU PLATE
NEW #1
o
o
o
o
232
227
453
454
________
________
#2
2 YR Registration
o
o
o
o
233
455
465
WP
LP
________
________
o
o
o
o
1A
1B
1C
JITNEY/RENTAL (37)
WEIGHT PERMIT (21)
TRANSACTION TYPE
VEHICLE TYPE
PLATE TYPE
o
o
o
o
ALL TERRAIN (02)
FORKLIFT (11)
o
DISABLED PLATE
POW (23)
(421) NEW VT REGISTRATION (NEW
o
PLEASURE CAR (19)
o
o
o
o
AGRICULTURE (01) FARM USE ONLY
WELL DRILLER (11)
PLATES) ________________________
VANITY
PURPLE
o
TRUCK/TRUCK
HEART(47)
o
o
o
STREET ROD (56) (STROD)
EXHIBITION (09) (EX)
o
(431) TRANSFER VT PLATE NO.
FIRE FIGHTER (40)
TRACTOR (27)
o
EMS (46)
o
o
o
___________________ EXP. _______
SPECIAL PURPOSE TRUCK (20)
MOTOR HOME (19)
NAT’L GUARD (41)
o
OFF-HWY TRACTOR (24)
o
VIETNAM
o
o
o
o
(475) RENEWAL VT PLATE NO.
STATE (22)
SCHOOL BUS (19)
o
AMATEUR RADIO OPR (42)
VETERANS (50)
TRAILER (26, 25, 06)
___________________ EXP. _______
o
o
o
ANTIQUE (03) (AN)
MOTOR BUS (04, 05)
o
PEARL HABOR (44)
o
VERMONT
MOTORCYCLE (18)
o
VETERANS (49)
IRP TAX & TITLE ONLY
o
o
o
VOLUNTEER (28)
FARM TRACTOR (45)
o
CONSERVATION PLATE
(48)
MUNICIPAL (15)
o
WEIGHT CHANGE ONLY
o
MOPED (17)
o
OTHER _______________________________
o
MAKE (a)
MODEL (b)
MODEL YEAR (c)
BODY TYPE (d)
MILEAGE (NO TENTHS) (e)
MILES
COLOR (f)
2
(YYYY)
o
KILOMETERS
o
HOURS
SERIAL NUMBER (VIN) (g)
NO. OF CYL. (h)
VEHICLE IS (CHECK ONE) (i) FUEL TYPE (CHECK ONE) (j)
o NEW
o USED
o REBUILT
o GAS
o DIESEL
o ELECTRIC
o PROPANE
o OTHER
BUS/JITNEY
3D
TRACTOR/TRUCK (Includes pick-up)
MOTORCYCLE/
3B
TRAILER
RENTAL
3A
3C
AGRICULTURE VEHICLE
MOPED
EMPTY WEIGHT (a)
EMPTY WEIGHT (a)
WEIGHT OF TRAILER
& LOAD IS (c)
EMPTY WEIGHT (a)
WEIGHT OF TRUCK & LOAD (b)
BRAKE TYPE (e)
# WHEELS (a)
# OF PASSENGERS (b)
LENGTH (FT) x WIDTH (FT) (b)
o 1499 lbs OR LESS
o AIR
o HYD
# OF AXLES (c)
TIRE SIZE (d)
ENGINE SIZE (b)
LOADED WEIGHT (c)
o 1500 lbs OR MORE
o OTHER
NAME (b)
NAME (l)
SEX (c)
o OWNER
SEX (m)
o CO-OWNER
4A
o LESSEE (a)
o M o F
o LESSOR (K)
o M o F
OWNER/LESSEE MAILING ADDRESS (STREET, RD., OR BOX #) (d)
CO-OWNER/LESSOR MAILING ADDRESS (STREET, RD., OR BOX #) (n)
TOWN/CITY
STATE
ZIP CODE
TOWN/CITY
STATE
ZIP CODE
LEGAL RESIDENCE (STREET, TOWN, STATE) (e)
SSN or FEDERAL ID NUMBER (fg)
LEGAL RESIDENCE (STREET, TOWN, STATE) (o)
SSN or FEDERAL ID NUMBER (pq)
DATE OF BIRTH
(b)
INDICATE OLD NAME BELOW, IF NAME HAS CHANGED SINCE LAST VT DMV TRANSACTION (i)
DATE OF BIRTH
(r)
INDICATE OLD NAME BELOW, IF NAME HAS CHANGED SINCE LAST VT DMV TRANSACTION (s)
(mm/dd/yyyy)
(mm/dd/yyyy)
VERMONT DRIVER LICENSE NO. (i)
IF MORE THAN ONE OWNER MUST INDICATE RIGHTS OF SURVIVORSHIP (CHECK ONE BELOW) (a)
VERMONT DRIVER LICENSE NO. (t)
4B
o
o
o
o
HUSBAND & WIFE OR PARTIES TO A CIVIL UNION
JOINT TENANTS
TENANTS IN COMMON
PARTNERS (business)
YOUR LIENHOLDER WHO HAS A LOAN ON THIS VEHICLE (a)
NAME OF PERSON/COMPANY VEHICLE ACQUIRED FROM (a)
DATE PURCHASED (b)
o IF NO LOAN
5A
5B
CHECK BOX (e)
STREET, CITY, STATE, ZIP CODE (b)
DATE OF BIRTH (f) (If individual) ADDRESS OF PERSON/COMPANY VEHICLE ACQUIRED FROM (c)
DATE OF LOAN (c)
IS THERE A SECOND LOAN? (d)
VERMONT DRIVERS LICENSE NO.
SIGNATURE OF PERSON/COMPANY (
) VEHICLE ACQUIRED FROM (d) DEALER NUMBER (e)
(g)
AGENT
o NO o YES –
IF YES, SEND DETAILS
6
9
TO CLAIM TAX CREDIT, COMPLETE SECTION 6 BELOW
DO NOT SEND CASH – DO NOT WRITE IN SHADED AREA
PURCHASER OF OLD VEHICLE (e)
PURCHASE PRICE OR
(a)
1
A - REGISTRATION
$
ACTUAL VALUE
LESS TRADE-IN, END LEASE
CITY
STATE
ON (DATE) (f)
(b)
B - TAX
2
BUY OUT PRICE OR OTHER
$
CREDIT
(c)
YEAR
(g)
MAKE
(g)
VIN (SERIAL NUMBER) (g)
C – TITLE $15.00
3
NET TAXABLE COST
$
PLUS $7.00 PER LOAN
(d)
TRADE-IN OR CREDIT REGISTERED UNDER MY VT PLATE NUMBER (h)
P&u TAX EXEMPTION NUMBER (i)
D – TRANSFER $15.00
4
X 6%
$
o
E – 1
st
CLASS MAIL $1.00
Please check here if vehicle was registered/titled out-of-state in your Spouse’s or Party to a Civil Union’s name only & is now being registered or
5
(NEW PLATE ONLY)
titled in Your or Party a Civil Union name only, and you were married to each other or Party to a Civil Union when the tax was paid out-of-state
(j)
OUTSIDE VERMONT, DMV OFFICIALS, STATE LEVEL ENFORCEMENT OR THOSE AUTHORIZED
VERIFICATION OF VEHICLE IDENTIFICATION
7
10
MISC
BY THAT STATE TO PERFORM VIN VERIFICATIONS
DMV/AUTHORIIZED USE ONLY
VEHICLE IDENTIFICATION (SERIAL) NUMBER. NO ALTERATIONS OR ERASURES ACCEPTED. (a)
PRESENTLY REGISTERED IN STATE OF
OTHER
DATE
AT TOWN OR CITY
STATE
31
F – FUEL USER
AUTHORIZED SIGNATURE
ORGANIZATION
CERTIFICATE NUMBER
G – TOTAL FEES
(U.S. FUNDS ONLY)
o
PHONE NUMBER (INCLUDE AREA CODE)
MILEAGE (NO TENTHS)
MILES
RETURN #
RATER #
RF
o
KILOMETERS
o
HOURS
The owner certifies that this vehicle 1) is properly equipped and in good mechanical condition; 2) was placed into
32 V.S.A. §§ 8901-8915. As the applicant for registration of a commercial motor vehicle, which is a motor vehicle with a gross
8
use on or before the date this application was signed; 3) currently has liability insurance in effect as required by
vehicle weight rating of 10,001 lbs. or more; is a vehicle that is used to transport hazardous materials; or is a vehicle that is
23 V.S.A. § 800 (a). If transfer of plates, the owner and/or this vehicle are not under suspension pursuant to 23
designed to transport 16 or more passengers, including the driver, I hereby declare that I have knowledge of the Federal Motor
V,S,A, §3009 (b) [diesel tax related]. Statements and warrants herein are certified under penalty of 23 V.S.A. §§
Carrier Safety Regulations, Title 49 of the Code of Federal Regulations, as adopted by the State of Vermont.
202, 2082, and
SIGNATURE (OWNER/LESSEE)
(a)
DATE
(b)
SIGNATURE (CO-OWNER/LESSOR)

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