Fillable A USED NEW APPLICATION TO TITLE/REG. A VEHICLE (Minnesota Auto & Driver's License of Brainerd)

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A USED NEW APPLICATION TO TITLE/REG. A VEHICLE (Minnesota Auto & Driver's License of Brainerd)

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A
APPLICATION TO TITLE/REG. A VEHICLE
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Driver and Vehicle Services Division
445 Minnesota St., St. Paul, MN 55101-5185
Phone: 651-297-2126 TTY: 651-282-6555
drive.mn.gov
Contact Phone Number for Customer
YEAR
WEIGHT STICKER NUMBER/MOTORCYCLE ENGINE NO.
MODEL YEAR
BODY/MODEL TYPE
VEHICLE COLOR
WEIGHT RATING
VEHICLE TYPE
MAKE
VEHICLE USE TYPE
# PASS.
FUEL TYPE
NEW
USED
AUTO INSURANCE COMPANY
POLICY NUMBER
EXP. DATE
DATE OF ACQUISITION
EMPTY WT.
# AXLES
You may disclose my information for any use in
response to requests for my individual driver or
motor vehicle record.
You may disclose my personal information for bulk
distribution for surveys, marketing or solicitations.
B
ODOMETER DISCLOSURE STATEMENT. I (WE) CERTIFY THAT THE ODOMETER
NOW READS
(NO TENTHS) MILES AND TO THE
DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF
MY KNOWLEDGE, THIS VEHICLE:
BEST OF MY KNOWLEDGE, THE ODOMETER MILEAGE IS:
(CHECK ONE) SUSTAINED DAMAGE IN EXCESS
OF 80 PERCENT ACTUAL CASH VALUE.
Has
Has Not
Actual mileage
In excess of odometer's mechanical limits
Not actual mileage - WARNING ODOMETER DISCREPANCY
ASSIGNMENT: I (WE) CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS. I (WE) WARRANT TITLE AND ASSIGN THE REGISTRATION
TAX AND VEHICLE TO THE PERSON(S) NAMED IN SECTION D.
SELLER'S PRINTED NAME(S)
ACQUISITION DATE
SELLER'S ADDRESS
DEALER LICENSE #
X
ALL SELLER'S SIGNATURE(S)
C
IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)?
YES NO
IF YES, COMPLETE SECTION C.
FIRST SECURED PARTY (PRINT NAME)
DATE OF LOAN
For Additional Secured Parties,
Attach Completed Form PS2017
STREET ADDRESS CITY
ZIP CODE
STATE
D
FIRST, MIDDLE, LAST NAME
DRIVER'S LICENSE NUMBER / DEALER NUMBER
DATE OF BIRTH
ADDITIONAL PURCHASER(S)/OWNER(S) FIRST, MIDDLE, LAST NAME
DRIVER'S LICENSE NUMBER
DATE OF BIRTH
RESIDENCE STREET ADDRESS
CITY
STATE
ZIP CODE
MAILING ADDRESS
You can elect to receive your registration renewals by email. If you select this option, paper renewal notices will not be mailed.
To elect this service please provide an email
address for notices to be emailed to:
F
I CERTIFY BY MY SIGNATURE I HAVE PURCHASED THE VEHICLE DESCRIBED ON THIS APPLICATION. CHECK ONE:
I am 17 years old and have completed an approved
driver training course.
I am an employed, emancipated minor and I have a Minnesota driver's license.
I am 17 years old and a high school graduate.
When I was a resident of a foreign state, I was the duly registered owner of the automobile or
truck described on this application. (COMPLETE SECTION G)
1 of 2
PS2000A-46 (11/2020)
E
VEHICLE CLASS
If more than two owners, complete a separate attachment with the additional owner's information (must provide all info as below)
This section to be completed if under 18.
Vehicle Identification Number
PLATE NUMBER STICKER NUMBER
VALIDATION AND
OFFICE USE ONLY
Print Form
"A vehicle acquired by a Minnesota resident is subject to tax as soon as the vehicle is operated on a Minnesota street or highway. An automobile brought
into Minnesota by a non-resident must be registered within 60 days; however, if the foreign state vehicle is not currently registered, the vehicle must be
registered immediately. Tax for a non-resident is calculated 60 days from date of residency or transaction date, whichever is first; or from the date vehicle
is first operated on a Minnesota road or highway."
USDOT Number
WERE YOU A MINNESOTA RESIDENT
AT THE TIME OF PURCHASE?
YES NO
H
BASE VALUE/MSRP or GROSS WEIGHT
REGISTRATION PERIOD
PURCHASER'S MOTOR VEHICLE SALES TAX DECLARATION
1. Full purchase price
2. Less trade-in allowance
complete item #6
3. Net purchase price
4. 6.5% of line 3
5. Less tax paid to another state
NET SALES TAX DUE
6. Trade-in was:
MODEL YR.
MAKE
$
$
$
$
$
$
ADMIN/REGISTRATION TAX
From Through
PLATE #
PLATE FEE
CONTRIBUTION FEE
WHEELAGE TAX
TECH SURCHARGE FEE
PS VEHICLE FEE
TRANSFER TAX
TITLE FEE
LIEN FEE
MV SALES TAX
LATE TRANSFER PENALTY
SUB-TOTAL
STATE/DEPUTY FILING FEE
TOTAL DUE
ALL PURCHASERS/OWNERS MUST SIGN
DATE
DATE
MN SALES TAX ACCOUNT #
INTERNAL REV. CODE # (IRC)
PRORATE ACCOUNT #
(Sales tax due when registered)
WITHOUT PROPER OWNERSHIP/TRANSFER DOCUMENTS (e.g., OUT-OF-STATE
CERTIFICATE OF TITLE), NO MINNESOTA TITLE WILL BE ISSUED.
I (We) certify I (we) are of legal age, have
purchased this vehicle subject to liens shown
and no other. This vehicle is and will continue
to be insured while operating upon the public
streets and highways. The vehicle will be
operated in compliance with the laws that apply
to its class of registration. I (we) have received
a copy of this application and all of my (our)
declarations are true and correct. If applicable,
I (we) have knowledge of Federal and State
applicable to commercial motor vehicle
operation, Minn. Stat. § 221, public service
commission rules 1-48 and 49 U.S.C. §
390-399, and if a transporter of hazardous
materials, 49 U.S.C. §§ 171-199.
DO NOT SIGN UNTIL FORM IS COMPLETED IN ENTIRETY
VIN NUMBER
G
I
Registration Quantity
MN COUNTY/STATE VEH. IS KEPT
REGULAR LICENSE PLATE NUMBER OF THE OTHER VEHICLE OWNED OR LEASED BY YOU:
NOTE: TRAILERS AND TRUCKS REGISTERED ON A GROSS WEIGHT BASIS MUST BE REGISTERED AT A MINIMUM OF 1.25 TIMES THE EMPTY WEIGHT.
† FOR TRUCKS REGISTERED AT 78,000 OR HIGHER, MUST DECLARE THE NUMBER OF AXLES ON THE FRONT OF THIS APPLICATION.
FOR CLASSIC, COLLECTOR, STREET ROD & PIONEER, PLEASE INDICATE DESIRED NUMBER OF PLATES:
One Plate Two Plates
PS2000A-46 (11/2020)2 of 2
Tennessen Warning
What is the purpose of supplying the requested information?
•The information collected on this form is used to apply for a certificate of title pursuant to Minn. Stat. § 168A.02(1).
Am I required to provide the requested information?
•You must provide the information requested within ten days of the date of sale in order to obtain a certificate of title. See Minn. Stat. § 168A.10(2).
What will happen if I do not provide the requested information?
•If you do not provide the requested information, DVS will be unable to process your application for a certificate of title.
Who will have access to the requested information?
•DVS may disclose personal information when it relates to the operation or use of a vehicle or to public safety. The use of personal information relates to
public safety if it concerns the physical safety or security of drivers, vehicles, pedestrians or property. Information on an individual provided to register a
vehicle may be treated as provided by U.S.C. § 2721, and may be disclosed as required or permitted by that section. Information may be used, rented, or
sold solely for bulk distribution by organizations for business purposes including surveys, marketing or solicitation. The registered owner may request, in
writing, that their residence address or name and residence address be classified as "private data on individuals," provided the vehicle is not registered to
a business. See Minn. Stat. § 168.346(3).
J
IF NO, WHEN DID YOU BECOME A
MINNESOTA RESIDENT?
IF YES, WHEN WAS THE VEHICLE FIRST OPERATED ON A
MINNESOTA ROAD OR HIGHWAY?
Signature
Signature
I declare this tax exemption
MN DEALER LICENSE #
PRORATE FLEET #
LEASE EXTENSION FEE
REINSTATEMENT FEE
SALVAGE INSPECTION FEE
FARM QUARTERLY FEE
SPECIAL PLATE TRANSFER FEE
EXPEDITED TITLE FEE
ELECTRIC VEHICLE SURCHARGE
ADDITIONAL FEES:
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A USED NEW APPLICATION TO TITLEREG. A VEHICLE (Minnesota Auto & Driver's License of Brainerd)

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Completed 27 February 2021

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