MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Driver and Vehicle Services
445 Minnesota Street, St. Paul, MN 55101-5187
Phone: 651-297-2126 TTY: (651) 282-6555 Web: www.mndriveinfo.org
APPLICATION FOR DUPLICATE TITLE, REGISTRATION, CAB OR LIEN CARD
PLEASE READ THE INSTRUCTIONS AT THE BOTTOM OF THIS PAGE BEFORE COMPLETING
Duplicate plates and stickers ARE NO
T required when applying for duplicate title
FOR OFFICIAL USE ONLY
VEHICLE IDENTIFICATION NUMBER
TITLE NUMBER OF MISSING DOCUMENT
1 2 345678910111213141516 17
PLATE NUMBER PLATE YR. MAKE MOD. YR.
FOR CENTRAL OFFICE USE ONL
DATE OF BIRTH PRINT LAST, FIRST, AND MIDDLE DRIVER’S LICENSE NO.
APPLICANT’S
DATE OF BIRTH
FULL
NAME
FIRST
OWNER
LAST, FIRST, AND MIDDLE DRIVER’S LICENSE NO.
ADDITIONAL
’
PRINT ADDRESS OF STREET CITY COUNTY STATE ZIP
FIRST OWNER
(PERMANENT ADDRESS)
FEES DUE
$
DUPLICATE
¢
FILING
THIS APPLICATION IS FOR A DUPLICATE (Please check one): TITLE REG. CARD CAB CARD LIEN CARD
Check the box that indicates why the document must be replaced:
STOLEN MUTILATED – Attach the mutilated document
DESTROYED ILLEGIBLE – Attach the illegible document
LOST NOT RECEIVED (Your lending institution or the postal service may have the missing document)
GIVEN TO BUYER (SELLER IS FILING AFFIDAVIT OF SALE)
$ ¢
TOTAL
Temporary Address: Attach a SELF-ADDRESSED, STAMPED ENVELOPE if the document must be sent to a temporary address, and print that address
here.
STREET CITY STATE ZIP CODE
Please Check One: Applicant is the Owner (if jointly owned, only owner’s signature is required) Applicant is Secured Party
I certify that all of my declarations are true and correct. I am the owner or secured party of this vehicle and the original document has not been assigned and/or surrendered to
anyone.
X
X DATE
Applicant(s) signature(s) Applican
t(s) signature(s)
Title of
Agent if Applicant is Secured Party:
LIEN RELEASE
Print name and address of lien holde
Subscribed and sworn to before me
SECURED PARTY’S NAME
- NOTICE -
STREET ADDRESS MINNESOTA TAX ID NO.
Secured party’s signature
must be notarized to release
a lien.
CITY STATE ZIP CODE
SIGNATURE AND TITLE OF AUTHORIZED AGENT
The se cured party named no longer
claims a security interest in the v ehicle
described above.
Date of Release
this
Day of
20
NOTARY PUBLIC
COUNTY
MY COMMISSION EXPIRES
INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING
1. Duplicate plates and stickers ARE NOT required when applying for a duplicate title, registration/cab card or lien card. You only need to complete this side of the form.
2. Fees: Please contact DVS or your local deputy registration to determine fees or for assistance in completing this form. If you are applying by mail, make remittance payable to:
Driver and Vehicle Services.
IMPORTANT NOTICE: PLEASE READ
DVS will issue a duplicate certificate of title only to the owner or legal representative (power of attorney is required) of the owner named on the original certificate. If the original certificate of
title is recovered, it must be returned to DVS.
All data collected on a motor vehicle application are required by law. These data are used to identify your motor vehicle. Failure to provide required data may result in denial of the transfer
of ownership, registration of this vehicle, or other requested action. Except for certain uses permitted by federal and state laws, personal information contained in your application may not be
disclosed to anyone without your express consent.
PS2067A-15
