Form Mv 16 - Application For Cancellation Of Certificate Of Title

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APPLICATION FOR
MV-16 (8-08)
CANCELLATION OF
Commonwealth of Pennsylvania
PA Department of Transportation
CERTIFICATE OF TITLE
Bureau of Motor Vehicles
Harrisburg, PA 17106-8293
(PA TITLE MUST ACCOMPANY THIS APPLICATION)
FOR DEPARTMENT USE ONLY
CHECK PROPER BLOCK:
1.
FOR CANCELLATION OF A CERTIFICATE OF TITLE TO A MOBILE HOME, PERMANENTLY AFFIXED TO REAL PROPERTY OWNED BY THE APPLICANT - Complete
Sections A, B, and D.
2.
FOR CANCELLATION OF A CERTIFICATE OF TITLE TO A NEW VEHICLE WHICH HAS BEEN RETURNED TO THE MANUFACTURER OR DEALER FROM WHOM
OBTAINED WITHIN 30 DAYS FROM DATE OF ISSUE OF PENNSYLVANIA TITLE - NOTE: This title cancellation application must be made within 35 days from the date
the Pennsylvania title was issued. Complete Sections A, B and C.
3.
FOR CANCELLATION OF A CERTIFICATE OF TITLE TO A NEW VEHICLE WHEN INCORRECT MANUFACTURER’S CERTIFICATE OF ORIGIN WAS SUBMITTED
BY DEALER WITH APPLICATION FOR A PA CERTIFICATE OF TITLE - Complete Sections A, B and C.
A
APPLICANT(S) INFORMATION
List vehicle owner’s name exactly as shown on attached title (Last Name, First Name, Middle Name)
PA DL/Photo ID# or Bus. ID #
Date of Birth
Co-Owner’s Last Name, First Name, Middle Name
PA DL/Photo ID#
Date of Birth
State
Zip Code
Street Address
City
Daytime Telephone Number
(
)
B
VEHICLE INFORMATION
Make of Vehicle
Body Type
Model Year
Model
Vehicle Identification Number
Title Number
C
DEALER CERTIFICATION -
To be executed by dealer or manufacturer and signed by the Dealer and Applicant.
DIN
Daytime Telephone Number
Dealer’s Name
(
)
City
State
Street Address
Zip Code
CHECK ONE:
I (We) certify under penalty of law that the above described vehicle was returned ____________________________ and hereby request the title
recorded in the above name be cancelled.
DATE RETURNED
I (We) certify under penalty of law that the above described vehicle was titled in error due to submission of an incorrect manufacturers certificate of
origin and hereby request that the title recorded in the above name be cancelled.
Applicant’s(s) Signature(s)
Dealer or Authorized Person’s Signature
Date of Application
D
APPLICANT(S) CERTIFICATION AND SIGNATURE -
For cancellation of certificate of title to a mobile home.
I certify under penalty of law that the above described mobile home has been permanently affixed to land I hereby request that the title recorded in the above name be
cancelled.
APPLICANT’S SIGNATURE
DATE
CO-APPLICANT’S SIGNATURE
DATE
E
RECEIPT FOR MOBILE HOME TITLE CANCELLATION
This application, when completed below and endorsed by the Department, will be your receipt indicating that your mobile home title has been cancelled by the Bureau of
Motor Vehicles. The vehicle does not require a title as long as it is affixed permanently to real estate. Only one receipt will be issued. Please attach the receipt to your
deed and keep in a safe place.
If you should desire to relocate or move your mobile home on the highway at any time after cancellation, you must have it retitled. See the instructions on the reverse side
of this receipt for retitling the mobile home.
Information for documentation of the title cancellation.
VIN _________________________________________, TITLE ___________________________________, MAKE ____________________________
________________________________________________
NAME
________________________________________________
ADDRESS
________________________________________________
CITY
STATE
ZIP CODE

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