Request To Re-Issue A Certificate Of Title

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VEHICLE SERVICES — TITLE SECTION

Request to re-issue a

BUREAU OF MOTOR VEHICLES

29 STATE HOUSE STATION

Certificate of Title

AUGUSTA, ME 04333-0029

Call to verify information before filing.

Fee: $33.00

207-624-9000 ext. 52138

Please type or print clearly in

 RUSH REQUEST Additional $10.00 Fee

TTY # 877-456-8195

dark ink.

In accordance with Chapter 7, Title 29A M.R.S.A., Section 661, I hereby apply for a replacement Certificate of Title. I (we) state under penalties

of false statement, that the original title was: (if destroyed or illegible, remnants of title must accompany this form.)







LOST

STOLEN

DESTROYED

ILLEGIBLE

1. NAME(S): LAST, FIRST, MIDDLE INITIAL

2. DATE OF BIRTH

3. TELEPHONE #

OWNER

INFORMATION

4. OWNER’S CURRENT MAILING ADDRESS - NO & STREET

CITY

STATE

ZIP CODE

5. YEAR

6. MAKE

7. MODEL

8. VEHICLE IDENTIFICATION NUMBER

9. BODY TYPE



10.

NEW



USED





VEHICLE

REBUILT

INFORMATION

11. PURCHASE DATE

12. CURRENT ODOMETER READING

IF NOT ACTUAL:

MILEAGE STATED AS:

MI.

 ACTUAL MILEAGE

 ODOMETER CHANGED

KM

 ODOMETER BROKEN

IN EXCESS OF MECHANICAL LIMITS

DO NOT ESTIMATE - NO TENTHS

NOT ACTUAL - ODOMETER DISCREPANCY

MUST FILE MVT-32

13.. FIRST LIEN HOLDER’S NAME IF VEHICLE FINANCED, IF NO LIEN, STATE “NONE”

14. DATE OF LIEN M/D/Y

LIEN

INFORMATION

15. ADDRESS - NO. & STREET

CITY

STATE

ZIP CODE

A LIEN RELEASE FORM

(MVT-12) MUST BE FILED

IF MOTOR VEHICLE

14. DATE OF LIEN M/D/Y

16. SECOND LIEN HOLDER’S NAME

RECORDS SHOW A LIEN

WHICH HAS SINCE BEEN

RELEASED

18. ADDRESS - NO. & STREET

CITY

STATE

ZIP CODE

19. I(WE) CERTIFY THE ACCURACY OF ALL THE INFORMATION ABOVE

SIGNATURES

DATE

SIGNATURES OF OWNERS AS NAMED IN BLOCK 1. ALL OWNERS MUST SIGN IF MULTIPLE OWNERSHIP

PLEASE SEE

19. LIENHOLDER’S SIGNATURE - IF APPLICABLE

INSTRUCTIONS

NAME

POSITION

DATE

Authorization for Mailing

I (we) hereby certify that I (we) intend to transfer my (our) interest in the above vehicle to a Maine licensed dealer. I (we) authorize the Bureau of Motor Vehicles

to forward the Certificate issued as a result of this application to the dealer named below. This section not for use by dealers outside of Maine or for private sales.

This is not a transfer of ownership (use form MVT-16 to transfer.)

21. DEALER’S NAME

22. ADDRESS



23. PLATE NUMBER



U/C



M/C

NAME

POSITION

SIGNATURE