Form Mvd-10002 - Application For Vehicle Title And Registration printable pdf download

STATE OF NEW MEXICO

TAXATION & REVENUE DEPARTMENT

- PLEASE READ

Title Number

MOTOR VEHICLE DIVISION



IMPORTANT

DIVISION

APPLICATION FOR VEHICLE

INFORMATION

USE ONLY

TITLE AND REGISTRATION

ON REVERSE SIDE -

MVD-10002 REV. 09/09

Vehicle Identification Number

Year

Make

Model / Series

Color(s)

Major

Minor)

Number

of Liens

Type of Title

Secondary ID Number

Wt./Wheels

First Year Reg.

Date of Issue

01 - First Time

04 - Duplicate

02 - Title Transfer

05 - No Fee Corr.

11 - Non-Negotiable

03 - Lien Release

Name and Mailing Address of Registered Owner(s)

DGVW

Cyls.

Body Type

Odometer *

Type of Fuel

(G) -Gasoline (D)-Diesel

(L)-Liquified

(O)-Other

License Plate Number(s)

Vehicle Brand

Vehicle Class

Title Use

Previous Title No. and State

Date Purchased

Fleet Number

Commercial Vehicle

"2290"

2-Year Registration

# of Passengers

# of Doors

# of Seats

1st Reg. Owner's Social Security / Employer Identification / CRS No.

1st Reg. Owner D.O.B.

N.M. Driver License No.

N.M. Veteran Cert. No.

FIRST LIEN

File Date

Maturity Date

File Date

Maturity Date

SECOND LIEN

HOLDER

Name and Address

Canceled Plt. No.

Dealer Lic. No.

Mobile Home Size

Cnty.

Approximate Location (Mobile Home)

Suspended By:

Trade-In VIN (If Applicable)

MONTH

DAY

YEAR

Cleared By:

REG. EXPIRATION:

Sale Price:

Residence Address If Different Than Mailing Address

Reg. Sticker Number:

IMPORTANT: THERE IS A PENALTY CHARGE

Less Trade-In:

FOR FAILING TO RENEW BY THIS DEADLINE.

*ODOMETER DISCLOSURE STATEMENT

Net Difference:

FEDERAL AND STATE LAW REQUIRES THE TRANSFEROR (SELLER) OF A VEHICLE TO STATE THE ODOMETER MILEAGE UPON TRANSFER OF

OWNERSHIP . ANYONE CONVICTED OF A FRAUDULENT ODOMETER STATEMENT WILL BE SUBJECT TO FINES AND / OR IMPRISONMENT.

Net Excise Tax:

I hereby certify that the ODOMETER READING of the vehicle described above is: ______________________________ (no tenths) miles and

that to the best of my knowledge stated mileage is (check one of the following):

Registration:

WARNING: NOT THE ACTUAL MILEAGE -ODOM-

MILEAGE IN EXCESS OF



THE ACTUAL

*Mileage Codes

ETER DISCREPANCY (NM)*

MECHANICAL LIMITS (EL)*

MILEAGE (AM)*

Late Reg. Penalty:

_______________________________________

_________________________________________________

_________________

Printed Name of Seller

Signature of Seller

Date of Statement

Vets. Allowance:

_______________________________________

_________________________________________________

_________________

Signature of Purchaser

Date of Statement

Printed Name of Purchaser

NOTICE: Payment of the registration fee and acceptance of the application by the Motor Vehicle Divi-

Net Registration:

sion constitutes an affirmation that the applicant for title and registration has complied with the require-

ments of the Mandatory Financial Responsibility Act, NMSA 1978 §66-5-201 through 66-5-239.

Spec. Plate Fee:

APPLICANT CERTIFICATION: I (We) hereby certify that the information given herein is true and correct

Admin. Fee:

to the best of my (our) knowledge and affirm that I (we) have complied with the requirements of the

Mandatory Financial Responsibility Act with respect to this vehicle. See reverse side.

Transaction Fee:

_______________________________________

_________________________________________________

_________________

Signature of 1st Registered Owner

Date of Statement

Printed Name of 1st Registered Owner

Late Transfer Fee:

_______________________________________

_________________________________________________

_________________

Printed Name of 2nd Registered Owner

Signature of 2nd Registered Owner

Date of Statement

The Division is not responsible for false or fraudulent statements the applicant/registered owner makes in connection with this application, nor is the Division liable

Duplicate Title Fee:

for lien recording errors. The registered owner must notify the Division of any errors contained in the title and registration issued pursuant to this application.

TOTAL

NCIC Check by

FEES:

ACCEPTED BY: Signature of M.V.D. Employee: _______________________________________________________ Date: ______________