Form 400 - Application For Certificate Of Title And Registration For Motor Vehicle Or Manufactured Home/mobile Home Page 2

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SECTION G - SALES TAX EXEMPTION

Complete this section if you are entitled to a sales tax exemption and sign in the space provided verifying the exemption.

VEHICLE PURCHASED FROM INDIVIDUALS AND TITLED IN SOUTH CAROLINA ARE SUBJECT TO SALES TAX UNLESS EXEMPT. THE TAX IS 5% OF THE SALES PRICE UP TO A MAXIMUM OF $300.00.

(MOBILE HOMES ARE CALCULATED DIFFERENTLY.)

THE VEHICLE WAS TRANSFERRED FROM:

MY PARENT

MY SPOUSE

MY CHILD

MY BROTHER/SISTER

MY GRANDPARENT

MY GRANDCHILD

THE VEHICLE WAS TRANSFERRED TO ME AS:

LEGAL HEIR

BENEFICIARY

DISTRIBUTEE

I AM NON-RESIDENT MILITARY PERSONNEL

THE VEHICLE WAS A BONAFIDE GIFT

SIGNATURE

SECTION H - ADDITIONAL INFORMATION

DATE OF PURCHASE

DATE FIRST OPERATED IN S.C.

ENERGY EFFICIENT MANUFACTURED/MOBILE HOME?

YES

NEW OR USED?

PRIOR TITLE NUMBER

PRIOR TITLE STATE

THE VEHICLE DESCRIBED ON THIS APPLICATION IS:

REBUILDABLE

NON-REBUILDABLE

THE VEHICLE SUSTAINED THE FOLLOWING DAMAGE:

COLLISION

FIRE

WATER

STOLEN (RECOVERED)

STOLEN (UNRECOVERED)

AGENCY REFERENCE NUMBER

Calculate the Salvage Percentage:

Predamaged Value

Estimate for Repairs

SALVAGE%

Percentage

Applicant should initial verifying the sales price of the vehicle.

SECTION I - SELLER INFORMATION

SELLER OR DEALER NAME

SC DEALER/WHOLESALER NUMBER

SC SALES TAX NUMBER

SALES PRICE

CUSTOMER INITIALS

ADDRESS

CITY

STATE

ZIP CODE

SECTION J - INSURANCE CERTIFICATION

A VEHICLE MUST BE INSURED WITH LIABILITY INSURANCE COVERAGE WHEN IT IS REGISTERED AND IT MUST REMAIN INSURED WHILE REGISTERED, WHETHER OR NOT IT IS OPERATED, OR THE

UNINSURED MOTORIST FEE MUST BE PAID. PENALTIES ARE SEVERE FOR VIOLATION OF THIS REQUIREMENT.

UNDER PENALTIES OF PERJURY, I (WE) DECLARE THAT THIS VEHICLE IS INSURED BY A LIABILITY INSURANCE POLICY ISSUED THROUGH AN INSURANCE COMPANY LICENSED TO DO BUSINESS IN

SOUTH CAROLINA AND IT WILL REMAIN INSURED THROUGHOUT THE REGISTRATION PERIOD.

NAME OF INSURANCE COMPANY

SECTION K - DONATE LIFE SC

YES, I WISH TO DONATE $5.00, MORE OR LESS, TO DONATE LIFE SC.

AMOUNT OF DONATION: $__________.00

SECTION L - SIGNATURE OF OWNER

UNDER PENALTIES OF PERJURY, I DECLARE THAT I AM THE OWNER OF THIS VEHICLE AND REQUEST THAT A SOUTH CAROLINA CERTIFICATE OF TITLE AND/OR REGISTRATION BE ISSUED. I FURTHER CERTIFY THAT THE

INFORMATION ON THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. THE VEHICLE IS SUBJECT TO THE LIENS NAMED AND NO OTHERS. ALSO, IF REGISTERING A COMMERCIAL VEHICLE OVER 10,000 lbs.,

I CERTIFY THAT I AM FAMILIAR WITH THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS AND/OR FEDERAL HAZARDOUS MATERIALS REGULATIONS.

SIGNATURE OF OWNER (S) - MUST BE SIGNED IN INK BY OWNER OR AUTHORIZED AGENT (ATTACH POWER OF ATTORNEY IF APPLICABLE)

DATE

DISCLOSURE STATEMENT

56-3-240 (SOUTH CAROLINA CODE OF LAWS) - THE DEPARTMENT SHALL OBTAIN THE FEDERAL EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER WHEN A VEHICLE IS REGISTERED

WITH A GROSS VEHICLE WEIGHT OF MORE THAN 26,000 POUNDS OR A BUS COMMON CARRIER. THE DRIVER PRIVACY PROTECTION ACT OF 1994 (DPPA), 18 USC SECTION 2721-2725 RESTRICT THE

DISCLOSURE OF PERSONAL INFORMATION CONTAINED IN OUR RECORDS.

PENALTY FEES

FAILURE TO REGISTER WITHIN 45 DAYS OF THE DATE OF PURCHASE OR THE DATE OF OPERATION IN SOUTH CAROLINA WILL RESULT IN PENALTY FEES IN ADDITION TO REGULAR TITLE AND/OR

REGISTRATION FEES. THE LATE PENALTY FEE SCHEDULE IS AS FOLLOWS:

46 - 60 DAYS LATE - $10.00

61 - 75 DAYS LATE - $25.00

76 - 135 DAYS LATE - $50.00

OVER 135 DAYS LATE - $75.00

THIS SECTION FOR DMV USE ONLY

CHECK APPROPRIATE BOX:

BRAND

NO BRAND

TRANSACTION FEES

RATED BY

OFFICE/OFFICE NUMBER