Form Dor-Dmv-010-02/00 - Application For A Duplicate Certificate Of Title

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DOR-DMV-010-02/00
STATE OF SOUTH DAKOTA
APPLICATION FOR A DUPLICATE CERTIFICATE OF TITLE
Date of Application _________________________________
Odometer Reading is ________________________________/which is actual vehicle mileage
unless one of the following is checked. Stated Mileage:
o
o
Exceeds odometer’s mechanical limits
Is not actual mileage WARNING -
ODOMETER DISCREPANCY
____________________________________ _____________________________________
Vehicle Title or Boat Number
Serial or Identification Number
___________ __________________ ________________ ____________
__________
Make
Model or Length
Body Type
Year
Weight
______________________________________________________________________________
Owner/Owner(s) name as it appears on title
____________________________________________________________________________
Owner/Owners Current Mailing Address
______________________________________________________________________________
City
State
Zip Code
County
LIENHOLDER INFORMATION
o
o
I certify that there
ARE
ARE NOT any outstanding lien(s), mortgages or other
encumbrances on the described vehicle or boat. If there ARE, complete the section below:
______________________________________________________________________________
Amount Code
Held By
Address
______________________________________________________________________________
Amount Code
Held By
Address
APPROVAL OF LIENHOLDER: The above lien(s) are still effective and are to be listed on
theduplicate title when issued.
_____________________________________________________________________________
Lienholder Signature
Name of Lienholder
___________________________________________________________________________
Lienholder Address
City
State
Zip Code
APPLICANT CERTIFICATION
As the applicant, I certify that the information shown above is true and correct to the best of
my knowledge and that the Certificate of Title originally issued to me has been: (describe)
________________________________________________________________________________
(Lost, Stolen, Destroyed. etc.)
and that I have not transferred the vehicle or boat described above to another owner.
________________________________________________________________________________
Signature(s) of Applicant/Owner(s)
Subscribed and sworn to before me this____________________________ day of , ________
________________________________________________________________________________
Notary Public
(SEAL)
My commission expires: _____________________________
NOTICE: This application is INVALID unless properly notarized.

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