Form Tr-1 - Application For Registration And Title Certificate
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3STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS - DIVISION OF MOTOR VEHICLES
600 New London Avenue, Cranston, RI 02920-3024 ♦ Phone: 401-462-4368 ♦
FOR OFFICIAL USE ONLY
NAME OF PERSON SUBMITTING DOCUMENTS TO DMV
Plate Type
TAX:
PRINTED NAME:
TOTAL:
SIGNATURE:
□
□
CHECK
CASH
TIN:
LICENSE NO.:
LICENSE STATE:
TRANSACTION TYPE: PLEASE SELECT ONE
E. VEHICLE INFORMATION (ALL FIELDS ARE MANDATORY)
YEAR: VIN (VEHICLE IDENTIFICATION NO.):
□
NEW REGISTRATION
(complete sections A,B*,C,D,E,F*,G,H)
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MAKE: MODEL: BODY TYPE: GROSS WEIGHT:
TRANSFER REGISTRATION – PLATE #: ________________
(complete sections A,B*,C,D,E,F*,G,H)
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COLOR: NUMBER OF CYLINDERS: MILEAGE:
DUPLICATE REGISTRATION – PLATE #: ________________
(complete sections A,B*,D,E,H)
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NUMBER OF PASSENGERS
FUEL TYPE (CHECK ONLY ONE):
□
□
□
□
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PLATE CHANGE – PLATE #: ________________
(complete sections A,B*,D,E,H)
VEHICLE HOLDS: __________
GAS
HYBRID
ELECTRIC
DIESEL
CNG/LPG
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DOES VEHICLE HAVE PICKUP BED?
CAMPERS AND TRAILERS ONLY:
□
□
UPDATE CURRENT INFORMATION –
SURVIVING SPOUSE –
LENGTH: CARRYING CAP:
YES
NO
PLATE #: ________________
PLATE #: ________________
(complete sections A,B*,D,E,F*,H)
(complete sections A,D,E,G,H)
□
MOTORCYCLES/MOPEDS/SCOOTERS ONLY:
□
□
LATE RENEWAL – PLATE # or TITLE # ________________
YES
PEDALS?
ENGINE SIZE/CC/MPH: _________ MAX. SPEED: _________
NO
(complete sections A,B*,D,E,F*,H)
A. OWNER’S INFORMATION (INDIVIDUAL OR COMPANY)
* F. COMMERCIAL VEHICLE / TRUCK INFORMATION ONLY
TRUCKS: NUMBER OF AXLES:
US DOT NUMBER:
LAST NAME:
PHONE:
TRACTORS: NUMBER OF AXLES:
IS VEHICLE PART OF FLEET?
□
□
YES
NO
FIRST NAME: MIDDLE INITIAL: SUFFIX:
TRUCKS & TRACTORS: DISTANCE FROM FRONT TO REAR AXLES:
(CENTER OF STEERING AXLE TO CENTER OF EXTREME REAR AXLE)
LICENSE NUMBER:
D.O.B.
RESIDENCE ADDRESS (WHERE VEHICLE IS KEPT OR GARAGED)
WHEN TRACTOR IS COMBINED WITH TRAILER THE LEGAL GROSS WEIGHT WILL BE DETERMINED BY
STREET ADDRESS:
THE DISTANCE FROM THE REAR AXLE & NUMBER OF AXLES IN COMBINED UNIT
G. LIEN INFORMATION (COMPLETE IF THERE IS A VEHICLE LOAN)
CITY/STATE/ZIP:
MAILING ADDRESS (IF DIFFERENT THAN RESIDENCE)
(1) LIENHOLDER NAME:
STREET ADDRESS:
CITY/STATE/ZIP:
ADDRESS:
SECOND OWNER, IF APPLICABLE
LAST NAME: FIRST NAME:
CITY/STATE/ZIP:
D.O.B.:
LICENSE NUMBER:
DATE OF LIEN:
* B. LESSEE’S INFORMATION (IF VEHICLE IS LEASED)
(2)
LIENHOLDER NAME:
LAST NAME:
ADDRESS:
FIRST NAME: MIDDLE INITIAL: SUFFIX:
CITY/STATE/ZIP:
STREET ADDRESS:
DATE OF LIEN:
H. SIGNATURE
CITY/STATE/ZIP:
I, THE UNDERSIGNED, HEREBY MAKE APPLICATION TO REGISTER THE ABOVE DECLARED VEHICLE AND AS
PART OF MY APPLICATION DECLARE THAT I AM THE OWNER, I DECLARE UNDER PENALTY OF PERJURY THAT
LICENSE NO.:
D.O.B.
NO OTHER LIENS EXIST AGAINST THE VEHICLE EXCEPT AS DESCRIBED HEREIN AND THAT ALL STATEMENTS
C. SELLER’S INFORMATION
MADE ON THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I
CERTIFY UNDER PENALTY OF PERJURY THAT I HAVE READ THE STATEMENT ON THE REVERSE SIDE AND
WILL ABIDE BY CONDITIONS STATED THEREIN.
SELLER’S NAME:
PERSONAL INFORMATION CONTAINED IN YOUR MOTOR VEHICLE RECORD WILL BE DISCLOSED ONLY IF THE STATE
HAS OBTAINED THE EXPRESS CONSENT OF THE PERSON TO WHOM SUCH PERSONAL INFORMATION PERTAINS.
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NO
DO YOU CONSENT TO SUCH A DISCLOSURE?
YES
STREET ADDRESS:
OWNER’S SIGNATURE: DATE:
CITY/STATE/ZIP:
SECOND OWNER’S SIGNATURE:
DATE OF SALE:
RI DEALER’S LICENSE #:
IF CORPORATION, GIVE TITLE OR POSITION:
D. INSURANCE INFORMATION
IF MINOR, SIGNATURE OF PARENT/GUARDIAN:
LIABILITY INS. COMPANY NAME:
NOTARY PUBLIC SIGNATURE:
POLICY NO.:
EFFECTIVE DATES:
NOTARY PUBLIC NAME: DATE:
IS YOUR REGISTRATION, LICENSE, OR PRIVILEGE TO OPERATE A MOTOR VEHICLE SUSPENDED OR
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REVOKED?
YES
NO
COMMISSION EXPIRATION DATE (MANDATORY):
FINANCIAL RESPONSIBILITY
COMPANY NAME:
□
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REQUIRED?
YES
NO
TR-1
01/13
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