Vermont Registration Tax

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OLD #1
Title Brands
In Lieu Plate
Temp Plate Date
Reg Type
Index #
Expires
2 Year
/
NEW #1
LP
NEW #2
225
227
231
232
233
452
453
454
455
465
490C
490P
NNR
|
Vermont Registration Tax & Title Application |
D119 05/2016 MTC
Audit/Receipt Line:
Do Not Write In Shaded Areas
1
Vehicle is  Owned or  Leased
Email
Name
EIN # (if business)
Phone
License #
Address where you get mail
Address where you live
City:
State
ZIP:
City:
State
ZIP
Female
Male
If name has changed, list previous name(s):
Date of birth
Name
EIN # (if business)
Phone
License #
Address where you get mail
Address where you live
City
State
ZIP
City
State
ZIP
Female
Male
If name has changed, list previous name(s):
Date of birth
2
 Spouses
 Joint Tenants
 Tenants In Common
 Business Partners
 Transfer on Death
(requires form T-07)
Date of loan
Date of birth (if individual)
VT license # (if individual)
Lienholder Name
3A
Lienholder Address
Name of person or
Date purchased
VT Dealer number
company vehicle
acquired from
3B
Signature of person
Address of person or
company vehicle
or company (
)
agent
acquired from
vehicle acquired from
Registration/Plate Type
Plate #
New Registration
Lease Buy-Out
Title Only
(421)
(421)
Car
Truck
(19)
(27)
4
Renew
IRP Tax & Title
Exempt Title (25yr)
(475)
Trailer
Motorcycle
(26, 25, 06)
(18)
Expires (month/year)
________________ | _____
Transfer
Weight Change
(431)
see instructions
(#)
Make
Model
Model Year
Body Type
Color
Mileage (No Tenths)
 Miles
Km
5
Hours
# of Cylinders
Serial Number (VIN)
New
Used
Gas
Diesel
Propane
Rebuilt
Hybrid
Electric
Other
# of Axles
Length x Width
Empty Weight
# of Wheels
# of Passengers
Brake Type
HYD
Air
Other
CC’s
Empty Weight
Loaded Weight
Loaded Weight
Empty Weight
1500 or less
(26)
1501 or more
(25)
Purchaser of old vehicle
9
Registration
(1)
Purchase Price
City
State
Date of Sale
Tax
(2)
Credit for Trade
7
Year
Make
Plate
Tax Exempt #
6
Title
(3)
NADA Value
VIN
Transfer
(4)
Adjustments
Return #
Statements and warrants herein are certified under penalty of 23 V.S.A.
Warranty
(12)
Net Taxable
§202, §203, §2082, and 32 V.S.A. §§ 8901-8915.
Renewal Fee
The owner certifies that this vehicle 1) is properly equipped and in good mechanical condition; 2) was placed into use on
Fuel User
(31)
or before the date this application was signed; 3) currently has liability insurance in effect as required by 23 V.S.A. §800
(a). If transfer of plates, the owner and/or this vehicle are not under suspension pursuant to 23 V,S,A, §3009(b). As the
8
Rater #
Other
applicant for registration of a commercial motor vehicle, I hereby declare that I have knowledge of the Federal Motor
Carrier Safety Regulations, Title 49 of the Code of Federal Regulations, as adopted by the State of Vermont.
Total
Application Must be Signed (in ink)
Signature (Owner/Lessee)
Date
Signature (Co-Owner/Lessor)

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