Fillable Form Mvr-1 - Title Application printable pdf download

MVR-1

North Carolina Division of Motor Vehicles

(Rev. 09/12)

TITLE APPLICATION

HECK Appropriate Block/s (Application cannot be processed without certification of services)



Title Only – Vehicle Not in Operation

 Truck Weight Desired ________________________

For Hire Vehicle

(This includes the truck, trailer and load)

 Yes or  No

 Title and License Plate

 Plate No. Transferred ________________________________

Class of License __________________

(List Plate Number and Expiration)

 Inoperable Vehicle – Vehicle substantially disassembled

 Limited Registration Plate

and unfit or unsafe to be operated on the highway

(When property taxes are deferred)

I certify that all the above information is correct. ___________

(Customer’s Initials)

VEHICLE SECTION

YEAR

MAKE

BODY STYLE SERIES MODEL

VEHICLE IDENTIFICATION NUMBER

FUEL TYPE ODOMETER READING

OWNER SECTION

Owner 1 ID # _____________________

_________________________________________________________________________________________________________

Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name

Owner 2 ID # _____________________ _________________________________________________________________________________________________________

Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company Name

Residence Address (Individual) Business Address (Firm)

City and State

Zip Code

Mail Address (if different from above)

City and State

Zip Code

Vehicle Location Address (if different from residence address above)

City and State

Zip Code

Tax County

LIEN SECTION

FIRST LIEN

SECOND LIEN

Date of Lien

ACCOUNT #

Date of Lien

ACCOUNT #

Lienholder ID #

Lienholder Name

Lienholder ID #

Lienholder Name

Address ______________________________________________________ __________

Address ____________________________________________________________________

City ______________________ State _________ Zip Code ______________________

City _______________________________ State ________ Zip Code __________________

I certify for the motor vehicle described above that I have financial responsibility as required by law.

___________________________________________________________

_________________________________________________________

Insurance Company authorized in N.C.

Policy Number

Purchased

Purchase Date

From Whom Purchased (Name and Address)

N.C. Dealer No.

Is this vehicle leased?

Equipment #

If Yes, Attach Form MVR-330

 New

 Used

 Yes

 No

DISCLOSURE SECTION

All motor vehicle records maintained by the North Carolina Division of Motor Vehicles will remain closed for marketing and solicitation unless the block below is checked.

 I (We) would like the personal information contained in this application to be available for disclosure.

APPLICATION MUST BE SIGNED IN INK BY EACH OWNER OR AUTHORIZED REPRESENTATIVE OF FIRMS OR CORPORATIONS.

I (we) am (are) the owner(s) of the vehicle described on this application and request that a North Carolina Certificate of Title be issued. I (we) certify that the information on

the application is correct to the best of my (our) knowledge. The vehicle is subject to the liens named and no others. If a registration plate is issued or transferred, I (we)

further certify that there has not been a registration plate revocation and that liability insurance is in effect on this vehicle on the date of this application as required by the

North Carolina Financial Security Act of 1957.

OWNER’S SIGNATURE ______________________________________________________________________________________________________________________

Date ________________________________

County _______________________________________

State ____________________________________

I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the

purpose stated therein and in the capacity indicated: _________________________________________________________________________(name(s) of principal(s) ).

Notary

Notary Printed

Signature _____________________________________________________ or Typed Name ______________________________________________________

My Commission Expires _______________________________________________

(SEAL)