Form Dmv-1-Tr - Application For A Certificate Of Title For A Motor Vehicle
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1
2STATE OF WEST VIRGINIA
DMV-1-TR
DEPARTMENT OF TRANSPORTATION
Rev. 06/2010
DIVISION OF MOTOR VEHICLES
FOR DEPARTMENT USE ONLY
CHARLESTON 25317
CLASS
NUMBER
TYPE OR PRINT IN BLUE OR BLACK INK
EXP. DATE
MAKE CHECKS PAYABLE TO DIVISION OF MOTOR VEHICLES
NAME
Title)
MAILING
ADDRESS
Number
Street
City or Town
County
State
Zip Code
VEHICLE DESCRIPTION
.
MAKE
YEAR
V. I. N
STYLE OF BODY
WEIGHT
TRUCKS Requested (GVW)
Passenger vehicle only
Odometer Reading
Title Brands:
SALVAGE
RECONSTRUCTED
(No Tenths)
OTHER:
Purchase Price $
Trade-in $
Net Cost $
5% Sales Tax
(Credit allowed only on vehicles registered in West Virginia and the tax paid thereon by applicant)
TRADE-IN DESCRIPTION
1)
MAKE
YEAR
SERIAL NO.
WEST VIRGINIA TITLE NUMBER
2)
MAKE
YEAR
SERIAL NO.
WEST VIRGINIA TITLE NUMBER
Registration Plate Transferred from: (Send copy of registration card both sides)
Make of vehicle
Weight
Serial Number
Title Number
License Number
LIENS AND ENCUMBRANCES
1
Amount
Name
Mailing
Address
Kind of Lien
Date
Street
City
State
Zip Code
C/S/C
D/T
S/A
2
Name
Amount
Mailing
Address
Kind of Lien
Date
Street
City
State
Zip Code
C/S/C
D/T
S/A
I hereby state that there is a motor vehicle liability policy in effect on the described vehicle in accordance with the provisions of the West Virginia Motor Vehicle Laws and certify that
the statements made are true and correct to the best of my knowledge and belief under penalty of false swearing. West Virginia Motor Vehicle Law § 17A-9-1: Fraudulent Applications.
Effective date of insurance policy: From
To
TITLE APPLICATION MUST BE SIGNED BY OWNER
Name of Insurance Company
If Title reads “AND” Both Signatures of Owners Must Appear
Name of Insurance Agent
OWNER’S SIGNATURE
Insurance Policy Number
National Association Insurance Commissioners (NAIC) Number
OWNER’S SIGNATURE
INSURANCE MUST BE IN EFFECT WHEN APPLICATION RECEIVED.
DEALER CERTIFICATION
on
This is to certify that the above described vehicle was acquired from
.
month
day
year
and sold to the above named purchaser on month
day
year
Regulations Require you to State the Odometer Mileage Upon Transfer of Ownership.
checked:
.
1. Mileage stated is in excess of its mechanical limits
2. The odometer reading is not the actual mileage - WARNING-ODOMETER DISCREPANCY.
Dealer Name
Address
Signature (X)
Dealer Number
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