Form Rd 108 - Application For Michigan Title And Registration Statement Of Vehicle Sale
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1Clear Form
82523
APPLICATION FOR MICHIGAN TITLE & REGISTRATION
STATE OF MICHIGAN
DEPARTMENT OF STATE
STATEMENT OF VEHICLE SALE
Purchase Date_________________________
______________
Invoice/Stock No.
Delivery Date__________________________
______________
Expires On
Months
Invoice/Stock No.
NEW PLATE
Month
Day
Year
RENEWAL
Dealer
TRANSFER
Year
Make
Body Style
Code
County
Address
Vehicle No.
Fee Category/Weight
License Fee
City
County
State
Zip Code
Driver License No./PIDs of All Owners or Lessees
Title
MICHIGAN
1)
3)
Dealer License
Sales Tax License
Phone Number
County of Residence
Title Late Fee
2)
Complete Names and Addresses of All Owners or Lessors
Tax
Vehicle Sold
Trade-In
New
Used
Demo
Yes
No
Reg. Transfer Fee
Trade-In Year
Make
Vehicle No.
Total - Transfer to #4
TEMPORARY VEHICLE REGISTRATION
USED TO TRANSFER PLATES
Complete Names and Addresses of All Lessees
Expires 15 days after delivery date
Plate transferred from:
Year
Make
Full Rights to Survivor
Yes
No
Vehicle No.
Plate No.
Temp. Expiration Date
Insurance Company
Policy No. or Binder No.
VEHICLE USE AND HISTORY DISCLOSURE:
POLICE VEHICLE
VEHICLE HAS BEEN FLOOD-DAMAGED
Filing Date
First Secured
Interest _____________________________________________________
GOVERNMENT VEHICLE
SALVAGE TITLE HAS PREVIOUSLY BEEN ISSUED
Address _______________________________________________________________________
TAXI
__________________________________________
ODOMETER MILEAGE
City-State Zip
The following section must be completed when odometer
Filing Date
Second Secured
disclosure is required. The odometer mileage reading must
Interest______________________________________________________
match the mileage reading disclosed to the purchaser on the
Address _______________________________________________________________________
NO TENTHS
title and/or mileage statement.
City-State Zip
actual mileage
not actual mileage
exceeds mechanical limits of odometer
(Including Freight
01. PURCHASE PRICE OF VEHICLE
& Accessories)
Factory Installed Accessories
Factory List Affixed To Vehicle
02. OTHER TAXABLE CHARGES
(Documentary Fee, Service Fee,
Temp. Reg. Fee, Etc.)
03. TOTAL TAXABLE PRICE
04. (Above total) SALES TAX - LICENSE - TITLE
05. NON-TAXABLE CHARGES
(Labor, Service Contract, Etc.)
Dealer Installed Accessories
When Optional to Purchaser
06. TOTAL DELIVERED PRICE
07. CASH ON DEPOSIT
08. CASH DUE ON DELIVERY
09. TRADE-IN
$
$
REMARKS:
10. LESS LIEN
11. TOTAL DOWN PAYMENT
12. UNPAID BALANCE TO BE FINANCED
13. INSURANCE CHARGE*
14. TOTAL AMOUNT OF FINANCE CONTRACT
CONTRACTUAL DISCLOSURE STATEMENT FOR USED VEHICLES ONLY
*TYPE OF INSURANCE
“The information you see on the window form for this vehicle is part of this contract.
WARNING: This insurance is not PL/PD No Fault Insurance required by Michigan Law.
Information on the window form overrides any contrary provisions in the contract of sale.”
“I CERTIFY I SOLD THIS VEHICLE TO THE PURCHASER NAMED IN THIS FORM.
CREDIT LIFE
HEALTH & ACCIDENT
I WARRANT THE TITLE TO THE VEHICLE AND CERTIFY THAT THE VEHICLE IS
SUBJECT ONLY TO THE SECURITY INTERESTS NAMED ABOVE.”
GAP INSURANCE
__________________________________
Temporary
Temporary
Registration No.______________________________________ Fee Charged Yes
No
Dealer’s Signature
Title
Salesperson ____________________________________________________________________
PURCHASER WARNING: DO NOT SIGN BLANK FORM
I am purchasing or leasing this vehicle and am applying for a Michigan certificate of title and registration or, if the lessee, applying for a registration. I certify my driver license is not suspended, revoked,
or denied as a repeat offender and I am eligible to purchase or register this vehicle. I further certify that if a tax exemption is shown above it is valid.
X
X
___________ ______________________________________________________________
___________ _______________________________________________________________
Date
Date
X
X
___________ ______________________________________________________________
___________ _______________________________________________________________
Date
Date
X
X
___________ ______________________________________________________________
___________ _______________________________________________________________
Date
Purchaser’s/Lessor’s Signature(s)
Date
Lessee’s Signature(s)
PURCHASERS NOTE: IF VEHICLE TITLE IS NOT RECEIVED WITHIN 30 DAYS, CONTACT THE REGULATORY MONITORING DIVISION AT (888) SOS-MICH, (888) 767-6424
THIS FORM MUST BE TYPED ONLY
Authority granted by P.A. 300 of 1949, as amended.
RD-108 12/02
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