Form Mv-126-Tr-1 - Application For A House Trailer One Trip Permit
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1
2
3STATE OF WEST VIRGINIA
MV-126-TR-1
DEPARTMENT OF MOTOR VEHICLES
REV. 11/20/03
TITLE AND REGISTRATION DIVISION
APPLICATION FOR A HOUSE TRAILER ONE TRIP PERMIT
1. In accordance with the provisions of Chapter Seventeen A, Article Seven, Section Two of the Motor Vehicle Code, the
undersigned ______________________________________________________________ hereby makes application for a House
Individual, Trade or Corporation Name
Trailer One Trip Permit. Enclosed herewith is
, money order
, cash
, in payment of the required statutory fee of $2.00.
2. Has the house trailer described below been titled or registered in this or any other state? ________________________________
Yes or No
If so, give name of state _______________________________________________________________.
3. Has a Permit of this type been issued to you on this house trailer prior to this application? _______________________________
Yes or No
4. Check which of the documents outlined below you have as proof of ownership of the house trailer. Certificate of Title
,
Certificate of Registration
, Manufacturers Certificate of Origin
, Bill of Sale
. The document checked must be presented
for inspection with this application.
DESCRIPTION OF HOUSE TRAILER FOR WHICH APPLICATION IS MADE
Manufacturer’s Make __________________________________ Year Model __________ Serial Number _____________________
APPLICATION IS MADE FOR TRIP
From _________________________________________________ To __________________________________________________
City and State
City and State
The above statements have been made for the purpose of obtaining a House Trailer One Trip Permit. Fraudulent or
misleading statements or improper use of said Permit will be considered cause for immediate revocation of Permit and privileges
granted,
__________________________________________________
Individual, Trade or Corporation Name
__________________________________________________
Street Address
__________________________________________________
City
State
Zip Code
__________________________________________________
Signature and Title of Applicant
State of West Virginia
County of ____________________________________, to wit:
Subscribed and sworn to before me this ___________________ day of _________________________________ 20________
My commission expires _________________________________________
__________________________________________________
Notary Public
___________________________________________________________________________________________________________
(This Space Department Use Only)
Application Approved By ________________________________________________ Permit Number Issued __________________
Date of Issuance _________________________________________________
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