Form Mv-82fc - Vehicle Registration/title Application (Haitian Creole)
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1
2APLIKASYON POU
Office Use Only
Class
Batch
ANREJISTREMAN/TIT VEYIKIL
File No.
o
o
o
Three of Name
Orig
Activity
Lease Buyout
o
o
o
Fòm sa a disponib sou sitwèb dmv.ny.gov
Dup
Activity W/RR
Sales Tax with Title
MWEN VLE:
Nimewo Plak la
ANREJISTRE YON VEYIKIL
RENOUVLE YON ANREJISTREMAN
JWENN YON TIT SÈLMAN
RANPLASE DOKIMAN KI
CHANJE YON ANREJISTREMAN
TRANSFERE PLAK
PÈDI OSWA DOMAJE
1
NON DEKLARAN PRENSIPAL (Non Fanmi, Prenon, Dezyèm Prenon oswa Non Biznis lan)
DAT OU FÈT
SÈKS
Nimewo ID lisans chofè NYS DEKLARAN PRENSIPAL
Mwa
Jou
Ane
o
o
Gason
Fanm
-NON LÒT DEKLARAN (Non Fanmi, Prenon, Dezyèm Prenon)
Nimewo ID lisans chofè NYS LÒT DEKLARAN an
DAT OU FÈT
SÈKS
Mwa
Jou
Ane
o
o
Gason
Fanm
NIMEWO TELEFÒN
NIMEWO TELEFÒN SELILÈ
o
o
o
o
W AP CHANJE NON?
WI
NON
W AP CHANJE ADRÈS?
WI
NON
Kòd Rejyonal
Kòd Rejyonal
(
)
(
)
ANSYEN NON (Si ou te chanje non an ou dwe prezante prèv la))
IMÈL
ADRÈS KOTE DEKLARAN PRENSIPAL LA RESEVWA KOURYE LAPÒS
(Mete Nimewo ak Non Ri, nimewo Livrezon Riral oswa nimewo bwat. N ap mete adrès nan dokiman an.)
Nimewo
Vil oswa Vilaj
Eta
Kòd Postal
Konte Kote W ap Viv
Non.
ADRÈS KOTE DEKLARAN PRENSIPAL LA AP VIV SI ADRÈS LA PA MENM AVÈK ADRÈS POSTAL LA
(PA BAY YON BWAT POSTAL)
.
Nimewo
Vil oswa Vilaj
Eta
Kòd Postal
Non.
Kalite Kawosri (make youn)
DESKRIPSYON VEYIKIL LA
NIMEWO IDANTIFIKASYON VEYIKIL LA
2
Ane
Mak
o
o
o
o
2 Pòt
4 Pòt
Pikòp
Kamyonèt
o
o
o
Kalite Enèji (Gaz)
Dekapotab
Banlyeza/SUV
Trelè
Koulè
Pwa Veyikil la lè li Vid
o
o
o
o
o
o
o
o
o
o
Gazolin
Dizèl
Elektrik
Flex
CNG
Pwopàn
Okenn
Motosiklèt
Remòkè
Lòt _________
Pou vwati lokasyon, otobis ak taksi
Pou trelè ak veyikil komèsyal
Office Use Only
Pou veyikil komèsyal yo
Silend
Pwa Brit Maksimòm
Kantite Moun Li ka Pote
Lekti Odomèt an Mil
Mileage Brand
Aks
Distans
A
E
N
CHANJMAN YO: Dekri nenpòt chanjman nan veyikil la ak rezon pou chanjman yo. (SOUMÈT TIT NYS SI NOU TE BAY LI)
3
Si PWOPRIYETÈ veyikil la DIFERAN avèk DEKLARAN an, the PWOPRIYETÈ a dwe ranpli seksyon sa a.
Nimewo lisans chofè NYS PWOPRIYETÈ a
NON PWOPRIYETÈ (YO) NAN MOMAN AN (Non Fanmi, Prenon, Dezyèm Prenon)
DAT OU FÈT
Mwa
Jou
Ane
SÈKS
NON KO-PWOPRIYETÈ A
o
o
Gason
Fanm
ADRÈS KOTE PWOPRIYETÈ
A RESEVWA KOURYE LAPÒS
(Mete Nimewo ak Non Ri, nimewo Livrezon Riral oswa nimewo bwat)
Konte
Nimewo
Vil oswa Vilaj
Eta
Kòd Postal
Non.
(Siyati pwopriyetè a oswa moun ki gen otorizasyon an, ak siyati ko-pwopriyetè a, si gen youn)
(Dat la)
DEALER USE ONLY - LIEN FILING -
Alterations are not allowed in the lienholder section below
Choose one
o
o
There are no liens
I am filing for the lienholder(s) listed below
Lien Filing Code
Lienholder Name
Lienholder Mailing Address (number, street, city, state, zip code)
NEW YORK DEALERS ONLY
Reg. Class
Did you issue plates to this vehicle?
Plate Number
Date Temp Issued
Facility ID Number
o
o
Yes
No
I certify that all information provided on this application is true.
DEALER CERTIFICATION:
____________________________________________________________
I take responsibility for the integrity of the papers delivered to the Motor Vehicles office.
(Signature of Dealer or Authorized Representative)
OFFICE USE ONLY
New
New
Ins.Co.
Special Conditions
Plate
Class
Code
AT
BV
CF
CO
EO
EX
FL
Sales Tax
Status
Value
Rate
Out of State
Jurisdiction
Audit
IO
NE
NF
NR
NU
OP
OV
($)
Prior
Issuance
Title
Lien
Lien
Lien Release
PA
PI
PK
RC
RE
SC
SO
State
Owner
Number
SP
SR
SS
SV
TE
TL
TO
Proof Submitted
TP
TR
TX
XR
X6
WO
Approved By
Date
Stop/Response/Scoff Law
Reg/Title ______________________________ State_________________
RANPLI TOULÈDE BÒ YO
PAJ 1 / 2
MV-82FC (12/16)
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Parent category: Legal