Form Rmv-1 - Vehicle Registration Form Page 2
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1
2Massachusetts Department of Transportation
3. Number of Documents______
r
r
RO (Registration Only)
RX (Registration Transfer)
RMV-1 Application Form
r
r
r
4.
ST (Salvage Title)
RT (Registration & Title)
TAR (Title Add Registration)
r
r
r
TO (Title Only)
SW (Summer/Winter Swap)
SS (Surviving Spouse)
1. REG. EFF. DATE
2. REG. EXP. DATE
5. Plate Type
6. Registration Number
7. Previous Title #
8. State
Registration/Vehicle
9. Type of Registration:
10. Vehicle Identification Number:
q
q
q
q
q
Passenger
Bus
Taxi
Livery
Commercial
q
q
q
q
q
Trailer
Auto Home
Semi-Trailer
Motorcycle
Other ________________
11. Year
12. Make
13. Model Name
14. Model #
15. Body Style
16. Circle Color(s) of Vehicle
0-Orange 1-Black 2-Blue 17. # of Cylinders/Passengers/Doors/Wheels
3-Brown 4-Red 5-Yellow 6-Green 7-White 8-Gray 9-Purple
/
/
/
q
q
q
q
q
q
Gasoline
18. Transmission 19. Total Gross Weight (Laden)
20. Motor Power
21. Bus:
Regular
DTE
Livery
Taxi
School Pupil
q
q
q
q
Automatic
Diesel
Propane
Electric
If carrying passengers for hire, max no of passengers that can be seated: ________
q
q
q
Other ___________
q
q
Manual
Hybrid
Yes
No
If school bus, is it used exclusively for city, town, or school district?
24. EIN/FID # (See block 29)
22.
Owner 1 License # / ID # / or SSN
23. Owner 2 License # / ID # / or SSN
If Sole Proprietor
Owner
provide SSN in # 22
25. Owner # 1 Name (Last, First, Middle)
26. Owner # 1 Date of Birth
25b. Sex
25a. Height
MALE
FEMALE
_____ Ft _____ In
27. Owner # 2 Name (Last, First, Middle)
28. Owner # 2 Date of Birth
27a. Height
27b. Sex
_____ Ft _____ In
MALE
FEMALE
29. Corp/Co/Organization Name (see block 24)
30. City/Town Where Vehicle is Principally Garaged:
31. Mailing Address
City
State
Zip Code
Residential or Corp/Co/Organization Address (see block 24 and 29)
32.
City
State
Zip Code
33A. Lessee’s MA License Number or EIN/FID Number. If out-of-state Lessee, use SSN and date of birth.
33B. Lessee’s Name:
M
M
D
D
Y
Y
Sales or Use Tax Schedule
34. Lessee’s Address, City, State, and Zip Code
56 A. SALE BY LICENSED MOTOR VEHICLE DEALER
35. Date of Purchase
36. Odometer Reading
Title
MA DOR-Registered Dealer EIN/FID # ______________________
Total Sale Price
$ ______________________
q
q
q
q
37.
New Vehicle
38. Title Type:
Clear
Salvage
Reconstructed
(adjusted for dealer’s discount and manufacturer’s rebate)
q
q
q
q
Used Vehicle
Owner Retained
Theft
Prior Owner Retained
Less Manufacturer’s Excise
$ ______________________
39. Primary Salvage Title Brands:
40. Secondary Salvage Brand(s)
q
q
Repairable
Parts Only
Net Sales Price
$ ______________________
Less Trade-in Allowance For:
$ ______________________
Yr __________
Make_____________ Model_______________
Trade-in VIN ___________________________________________
Taxable Sales Price
$ ______________________
6.25% Sales Tax
$ ______________________
B. SALES BY OTHER THAN MOTOR VEHICLE DEALER
Gross Sales Price (Proof Required)
$ ______________________
6.25% Sales/Use Tax
$ ______________________
Insurance Certification
The company signatory hereto hereby certifies that it has or will insure or guarantee performance by the applicant
hereinbefore named with respect to the motor vehicle hereinbefore described for a period at least coterminous with
C. CLAIM EXEMPTION FROM TAX CODE: __________________
that of such registration under a motor vehicle liability policy, binder or bond which conforms to the provisions of general laws, Chapter 175, Section 113A, and that the premium
charge and classification on the effective date of registration are as established by the commissioner of insurance under Chapter 175, Section 113B, 113H and Chapter 175E.
Form Attached (if required)
49A. Policy Effective Date:
_____________________
Exempt Organization Certificate #__________________________
49A.
Policy Change Date:
_____________________
Fee Info.
49B. Manual Class:
49C. Ins. Company & Code:
57. Reg:
$ ___________________
Payment:
Insurance Co’s Authorized Representative’s Signature (Original Only)
_
q
Title:
$ ___________________
Cash
CERTIFICATE OF REGISTRATION
q
Tax:
$ ___________________
Check
q
P&I:
$ ___________________
EFT/ CC
Total:
$ ___________________
Clerk ID:
This document is the Certificate of Registration for the herein
described vehicle. Section 11, Chap. 90, MGL states ...”Every
58. Batch No:
person operating a motor vehicle shall have the Certificate of
Registration for the vehicle and for the trailer, if any, and his
59. Clerk/End User Initials:
license to operate, upon his person or in the vehicle in some
easily accessible place.”
Not Valid Until Stamped With Official Stamp or Registrar’s Signature
Progressive Ins. form approved 1/2013
This form approved by the RMV 1/2013
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