I am the sole owner of the motor vehicle described as follows:
(The Beneficiary Designation is only applicable if vehicle is owned by one person)
Vehicle Identification Number
I designate that this vehicle be transferred upon my death, to:
Beneficiary Full Legal Name (first, middle, last, suffix) Date of Birth (optional) Legal Status *
This document is provided pursuant to Arizona Revised Statutes 28-2055(B) for the purpose of designating a
beneficiary as named above.
I release, discharge and agree to hold harmless the Arizona Department of Transportation, Motor Vehicle Division
from any and all liability which may arise by reason of any contest to the validity of the beneficiary designation(s)
herein.
Owner Name (first, middle, last, suffix)
Acknowledged before me this date.
Notary or MVD Agent Signature
*Legal Status
If you name two or more individuals as beneficiaries on this form, then the Legal Status box determines which
signatures will be required for the named beneficiaries to transfer ownership of the vehicle, license plates and/or
fees, to apply for a refund, or to record loan information in the future. Please indicate one of the following options in
the box above:
OR Ownership is joint tenancy, with an expressed intent that either of the owners has full authority to transfer
ownership, license plates and/or fees, or to record loan information. Names will appear on the title as in
this example: JOHN DOE OR JOE ROSS
Signature of either party will be accepted. Both signatures are not required.
AND Ownership is tenancy in common. Names will appear on the title as in this example: JOHN DOE AND JOE
ROSS
Signatures of all parties, if owned by more than one individual will be required. In the event of the death of
an owner, the interest of the deceased owner must be handled by probate action, or by completing a Non-
Probate Affidavit.
AND/OR Ownership is joint tenancy with right of survivorship. Names will be on the title as in this example: JOHN
DOE AND/OR JOE ROSS
Signatures of all parties, if owned by more than one individual will be required, if all are living. Upon proof
of death, the survivor may sign alone.
This form must be stapled to and presented with the current title,
and is void if altered or erased.
For Vehicle Title Transfer Upon Death
96-0561 R06/15
