Form Mbt 56 - Application For Boat Title/motor Title printable pdf download

MBT 56 Rev 8/11

STATE OF LOUISIANA

APPLICATION FOR BOAT TITLE/MOTOR TITLE

Authorized under La. R. S. §§ 34:852.1, et seq.

DEPARTMENT OF WILDLIFE AND FISHERIES

BOAT REGISTRATION#

P.O. BOX 14796

LA-

BATON ROUGE, LA 70898

BOAT TITLE FEES

MOTOR TITLE FEES

1. New / Transfer Title

$26.00 ____

1. New / Transfer Title

$26.00 ____

2. Duplicate Title

$23.00 ____

2. Duplicate Title

$23.00 ____

3. Record / Release Lien

$10.00 ____

3. Record / Release Lien

$10.00 ____

TOTAL AMOUNT REMITTED $______________

LAST

FIRST

MIDDLE

DATE OF BIRTH

SOCIAL SECURITY NUMBER OR

APPLICANT’S

FEDERAL TAX ID

NAME (PRINT)

BUSINESS NAME

IF APPLICABLE

MAILING ADDRESS

STREET OR POST OFFICE BOX NUMBER

HOME TELEPHONE NUMBER

PARISH

WORK TELEPHONE NUMBER

CITY

STATE

ZIP

U.S

CITIZEN

E-MAIL ADDRESS

CO-APPLICANT

LAST

FIRST

MIDDLE

DATE OF BIRTH

SOCIAL SECURITY NUMBER OR

(IF APPLICABLE)

FEDERAL TAX ID

PURCHASE / ACQUISITION

DATE OF PURCHASE / ACQUISITION

PURCHASE PRICE / FAIR MARKET VALUE (IF NOT PURCHASED)

PREVIOUS REGISTRATION # / TITLE #, IF APPLICABLE

STATE / COUNTRY WHERE LAST NUMBERED, TITLED OR REGISTERED, IF APPLICABLE

NAME OF SELLER / DEALER / FORMER OWNER

DEALER PERMIT NUMBER IF APPLICABLE

ADDRESS OF SELLER / DEALER / FORMER OWNER

DESCRIPTION OF BOAT

HULL IDENTIFICATION NUMBER

MANUFACTURER / MODEL

MODEL YEAR / YEAR BUILT

VESSEL TYPE

VESSEL LENGTH

PROPULSION TYPE

HULL CONSTRUCTION MATERIAL

FT.

IN.

DESCRIPTION OF MOTOR (OUTBOARDS ONLY)

SERIAL NUMBER

HORSEPOWER

MANUFACTURER / MAKE

YEAR

MODEL

IS THIS BOAT FINANCED? YES ❑ NO ❑

IS THIS OUTBOARD MOTOR FINANCED? YES ❑ NO ❑

BOAT/MOTOR IS SUBJECT TO THE FOLLOWING LIENS

NAME

ADDRESS, CITY, STATE, ZIP

TELEPHONE

DATE OF LIEN

FIRST LIEN

NAME

ADDRESS, CITY, STATE, ZIP

TELEPHONE

DATE OF LIEN

SECOND LIEN

KNOWINGLY PROVIDING FALSE INFORMATION HEREIN IS A CRIME.

I/we UNDER PENALTY OF PERJURY, DO SOLEMNLY swear and a rm, that to the best of my/our knowledge, INFORMATION, and belief, I/WE AM/ARE THE TRUE

AND LAWFUL owner(s) of the vessel described herein and that all INFORMATION I/WE HAVE PROVIDED herein IS true and correct. I/WE UNDERSTAND THAT any misrepresentation

of acts supplied to this o ce for the purpose of FRAUDULENTLY obtaining a boat title will subject the applicant(s) to criminal PROSECUTION as provided by law.

FOR OFFICE USE ONLY

___________________________________________________

_____________________________________

___________________________

Applicant’s Signature

Driver’s License # / State

Date

BT TITLE # __________

M TITLE # ___________

_____________________________________________________

______________________________________

___________________________