Form Ps2067a-18 - Application For Duplicate Title, Registration, Cab Or Lien Card

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MINNESOTA DEPARTMENT OF PUBLIC SAFETY

Print Form

DRIVER AND VEHICLE SERVICES

445 Minnesota Street Saint Paul, MN 55101-5187

Phone: (651) 297-2126 TTY: (651) 282-6555 Web: dvs.dps.mn.gov

APPLICATION FOR DUPLICATE TITLE, REGISTRATION, CAB OR LIEN CARD

PLEASE READ THE INSTRUCTIONS AT THE BOTTOM OF THIS PAGE BEFORE COMPLETING

Duplicate plates and stickers ARE NOT required when applying for duplicate title

FOR OFFICE USE ONLY

TITLE NUMBER OF MISSING DOCUMENT

MN PLATE NUMBER

MAKE

MODEL YEAR

VEHICLE IDENTIFICATION NUMBER

FOR CENTRAL OFFICE USE ONLY

LAST, FIRST, MIDDLE NAME

DRIVER'S LICENSE NUMBER

DATE OF BIRTH

FIRST

APPLICANT'S

OWNER

FULL NAME

LAST, FIRST, MIDDLE NAME

DRIVER'S LICENSE NUMBER

DATE OF BIRTH

ADDITIONAL

OWNER

PRINT ADDRESS OF

STREET ADDRESS

CITY

COUNTY

STATE

ZIP CODE

FIRST OWNER

(PERMANENT ADDRESS)

FEES DUE

THIS APPLICATION IS FOR A DUPLICATE

(Please check one):

Title

Reg. Card

Cab Card

Lien Card

Check the box that indicates why the document must be replaced:

DUPLICATE

MUTILATED – Attach the mutilated document

STOLEN

DESTROYED

ILLEGIBLE – Attach the illegible document

FILING

LOST

NOT RECEIVED

(Your lending institution or the postal service may have the missing document)

TOTAL

GIVEN TO BUYER (SELLER IS FILING AFFIDAVIT OF SALE)

Temporary Address:

Attach a SELF-ADDRESSED, STAMPED ENVELOPE if the document must be sent to a temporary address, and print that address here:

STREET ADDRESS

CITY

STATE

ZIP CODE

Please Check One:

Applicant is the Owner

Applicant is Secure Party

(if jointly owned, only one owner's signature is required)

I certify that all of my declarations are true and correct. I am the owner or secured party of this vehicle and the original document has not been assigned and/or

surrendered to anyone.

Date

APPLICANT(S) SIGNATURE(S)

Title of Agent if Applicant is Secured Party:

LIEN RELEASE – Print name and address of lien holder

Subscribed and sworn to before me

- NOTICE -

Secured party’s signature

SECURED PARTY’S NAME

this

must be notarized to release

a lien.

Day of

STREET ADDRESS

MINNESOTA TAX ID NO.

NOTARY PUBLIC

CITY

STATE

ZIP CODE

The secured party named no longer

claims a security interest in the vehicle

described above.

COUNTY

SIGNATURE AND TITLE OF AUTHORIZED AGENT

Date of Release:

MY COMMISSION EXPIRES

INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING

Duplicate plates and stickers ARE NOT required when applying for a duplicate title, registration/cab card or lien card. You only need to complete this side of the form.

Fees: Please contact DVS or your local deputy registration to determine fees or for assistance in completing this form. If you are applying by mail, make remittance payable to:

Driver and Vehicle Services.

IMPORTANT NOTICE: PLEASE READ

DVS will issue a duplicate certificate of title only to the owner or legal representative (power of attorney is required) of the owner named on the original certificate. If the original certificate of

title is recovered, it must be returned to DVS.

All data collected on a motor vehicle application are required by law. These data are used to identify your motor vehicle. Failure to provide required data may result in denial of the

transfer of ownership, registration of this vehicle, or other requested action. Except for certain uses permitted by federal and state laws, personal information contained in your

application may not be disclosed to anyone without your express consent.

PS2067A-18 (11/17)