Application For Certificate Of Title And Vin/hin Inspection Form printable pdf download

STATE OF WYOMING

Application for Certificate of Title and VIN/HIN Inspection Form

Motor Vehicle

Trailer

Snowmobile

Watercraft

Mobile Home

Date Title Issued: _________________

(Proof of ownership MUST accompany application)

** For Watercraft, please place the corresponding number from the guide below into the respective watercraft information box

BODY STYLE /

ENGINE

MANUFACTURER

YEAR

VEHICLE /

HULL IDENTIFICATION NO.

PROPULSION

VESSEL TYPE

DRIVE

FACTORY PRICE /

HULL

ODOMETER /

STATE

PRIOR TITLE NO.

PURCHASE DATE

WEIGHT

MSRP

MATERIAL

VESSEL LENGTH

Vessel Type

Hull Material

Propulsion Type

Engine Drive

1-Canoe / Kayak 2-Open Motorboat 3 - Rowboat 4-Cabin Motorboat 5-Pontoon Boat

1-Fiberglass

2-Aluminum

3- Wood 4-Steel

1-Propeller 2-Sail 3- Waterjet

1-Outboard 2-Inboard

6-Houseboat

7-Personal Watercraft (Jet Ski)

8- Sail Boat

9-Other

5-Rubber/Vinyl/Canvas 6- Rigid Hull Inflatable 7-Other

4-Airthrust 5-Manual

3-Inboard/Stern Drive

3-Wood

6-Rigid Hull Inflatable

PROPOSED = MV-300A (12/10)

> > BRANDED TITLE / SALVAGE DISCLOSURE

< <

EVERY APPLICANT FOR A MOTOR VEHICLE TITLE IS REQUIRED TO COMPLETE THIS

SECTION.

Please circle and initial the appropriate response to these two questions. The salvage definition and requirements are on the reverse side of this

page.

A.) Does this motor vehicle currently have or ever had a branded title?

Yes

(Initials:__________)

B.) Has this motor vehicle been declared a total loss by an insurance company

sustained 75% damage of actual cash value?

Yes

OWNER / SELLER INFORMATION

(Please print clearly)

NAME OF OWNER

JTWROS

ADDRESS__________________________________________________

CITY___________________________

STATE________ ZIP__________

NAME OF SELLER____________________________________________________________________________________________________________

ADDRESS

CITY

STATE____________

ZIP_______________

LIEN INFORMATION

(Please print clearly)

NAME OF LIEN HOLDER_______________________________________________________________________________________________________

ADDRESS

CITY

STATE_____________

ZIP

LIEN FILING #

AMOUNT

FILE DATE

I/WE HEREBY SWEAR OR AFFIRM under penalty of perjury that all information on this application is true and correct and that I/we am/are lawfully applying for a Wyoming Certificate

of Title. I/we further warrant that said vehicle is owned by me/us and is subject to the liens shown and none other. I/we further certify to the best of my/our knowledge that if the vehicle

is a mobile home, all taxes due on the mobile home for the preceding and current year have been paid and in the event taxes have not been paid, acknowledge that I/we may be

responsible for the taxes for the preceding and current year. Any false information may cancel the title and void any registration associated with the title.

SIGNATURE of

OWNER/APPLICANT(s):_____________________________________________________________________________________________________________________________

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

NOTARY STATEMENT (Required on all applications)

(SEAL)

STATE OF ______________________

COUNTY OF ____________________

Subscribed and sworn to before me by ______________________________________________________this

day of _______________ 20________

Office of County Clerk or Notary Signature

My Commission Expires:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~“V I N” or

“H I N”

Inspection Form~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

inspection, please review the “NOTICE” on the reverse side or this form to determine if you are authorized by

** Before completing the V.I.N. or

H.I.N.

statute to do so. Please print the

vehicle/watercraft

information as accurate and legible as possible and then verify with your signature at the bottom.

___________________________________________________________________________________________________ NCIC of VIN or HIN:

Yes

Hull ID Number (HIN) HIN’s are required to have 12 alpha-numeric digits, with no spaces or dashes.

(

[Vehicle Identification Number (VIN) /

]

Please Circle One)

Year: ______________ Make: ______________________________ Model: ______________________________ Trim: ______________________________

(Ford, Jeep, Chevr, Honda, etc.)

(F-150, Camaro, Mustang, Wrangler, etc.)

(XLT, Lariat, GT, LS, Rubicon, etc

BADGE/TITLE/DLR NUMBER,

Subject to the penalties of perjury,

__________________________________________________________

__________________________ am

(Whichever Applicable)

AGENCY

ENTITY NAME,_____________________________________________________________________________

an authorized member or employee of,

Sheriff’s Office

Please Circle One:

Police Dept.

Highway Patrol

State Police

G&F

Other Entity

state of,______________________________________________

depose and state that, I personally inspected the VIN or

HIN

in the

on the above described

vehicle/watercraft

and the information entered by me is true and correct. The undersigned verifies that I am authorized by the laws of Wyoming (or state where the

inspection occurred), to conduct this inspection.

SIGNATURE:

Date:______________

____________________________________________________________________ Phone:_____________________

W.S. 31-3-102(b) provides a $10.00 fee be collected for each vehicle/hull identification number inspected pursuant to W.S. 31-2-103(a)(vi)

MV-300A (6/13)

Application For Certificate Of Title And Vin/hin Inspection Form

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