NAME OF PERSON SUBMITTING DOCUMENTS TO DMV
PRINTED NAME:
SIGNATURE:
LICENSE #: LICENSE STATE:
TRANSACTION TYPE (PLEASE SELECT ONE)
UPDATE CURRENT INFORMATION
(complete sections A,B*,D,E,F*,H)
PLATE #: _______________
SURVIVING SPOUSE
(complete sections A,D,E,G,H)
PLATE #: _______________
LATE RENEWAL
(complete sections A,B*,D,E,F*,H)
PLATE # or TITLE #: _______________
LAST NAME (OR COMPANY NAME):
FIRST NAME:
MIDDLE INITIAL:
SUFFIX:
LICENSE #: D.O.B.:
STREET ADDRESS:
APT./FLOOR:
RESIDENCE (WHERE VEHICLE IS KEPT OR GARAGED)
CITY / STATE / ZIP CODE:
STREET ADDRESS: APT./FLOOR:
MAILING (IF ADDRESS IS DIFFERENT THAN RESIDENCE)
CITY / STATE / ZIP CODE:
LICENSE #: D.O.B.:
B*. LESSEE’S INFORMATION (IF VEHICLE IS LEASED)
NEW REGISTRATION
(complete sections A,B*,C,D,E,F*,G,H)
PLATE #: _______________
TRANSFER REGISTRATION
(complete sections A,B*,C,D,E,F*,G,H)
PLATE #: _______________
DUPLICATE REGISTRATION
(complete sections A,B*,D,E,H)
PLATE #: _______________
PLATE CHANGE
(complete sections A,B*,D,E,H)
PLATE #: _______________
LAST NAME:
FIRST NAME:
MIDDLE INITIAL:
SUFFIX:
STREET ADDRESS:
CITY / STATE / ZIP CODE:
LICENSE #: D.O.B.:
C. SELLER’S INFORMATION
SELLER’S NAME:
STREET ADDRESS:
APT./FLOOR:
CITY / STATE / ZIP CODE:
DATE OF SALE: RI DEALER’S LICENSE #:
D. INSURANCE INFORMATION
LIABILITY INSURANCE COMPANY NAME:
POLICY #: EFFECTIVE DATES (TO and FROM):
IS YOUR REGISTRATION, LICENSE, OR PRIVILEGE TO OPERATE A MOTOR
FINANCIAL RESPONSIBILITY REQUIRED? COMPANY NAME:
VEHICLE REVOKED?
YES NO
YES NO
PLATE
PLATE DESIGN
TRANSACTION #
TAX
E. VEHICLE INFORMATION (ALL FIELDS ARE MANDATORY)
F*. COMMERCIAL VEHICLE/TRUCK INFORMATION ONLY
WHEN TRACTOR IS COMBINED WITH TRAILER, THE LEGAL GROSS WEIGHT WILL BE
DETERMINED BY THE DISTANCE FROM THE REAR AXLE & # OF AXLES IN COMBINED UNIT
G. LIEN INFORMATION (COMPLETE IF THERE’S A VEHICLE LOAN)
(1) LIENHOLDER NAME:
STREET ADDRESS:
CITY / STATE / ZIP CODE:
DATE OF LIEN:
H. SIGNATURE
I, THE UNDERSIGNED HEREBY MAKE APPLICATION TO REGISTER THE ABOVE DECLARED
VEHICLE AND AS PART OF MY APPLICATION DECLARE THAT I AMTHE OWNER, I DECLARE
UNDER PENALTY OF PERJURY THAT NO OTHER LIENS EXIST AGAINST THE VEHICLE EXCEPT
AS DESCRIBED HEREIN AND THAT ALL STATEMENTS MADE ON THIS APPLICATION ARE TRUE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I CERTIFY UNDER PENALTY
OF PERJURY THAT I HAVE READ THE STATEMENT ON THE REVERSE SIDE AND WILL ABIDE
BY CONDITIONS STATED THEREIN.
FOR OFFICIAL USE ONLY
TOTAL
CHECK CASH
YEAR: VIN (VEHICLE IDENTIFICATION #):
MAKE:
MODEL:
BODY TYPE:
GROSS VEHICLE WEIGHT:
COLOR: # OF CYLINDERS:
CURRENT MILEAGE:
DOES VEHICLE HAVE A PICKUP BED? CAMPERS AND TRAILERS ONLY
VEHICLE HOLDS: ______
YES NO
# OF PASSENGERS
FUEL TYPE (CHECK ONLY ONE):
GAS
HYBRID
ELECTRIC
DIESEL CNG/LPG
LENGTH: ______ CARRYING CAP.: ______
MOTORCYCLES/MODEPS/SCOOTERS ONLY
YES NO
ENGINE SIZE/CC/MPH: ______ MAX SPEED.: ______
PEDALS?
TRUCKS: # OF AXLES: U.S. DOT #:
TRACTORS: # OF AXLES: IS VEHICLE PART OF A FLEET?
YES NO
TRUCKS AND TRACTORS: DISTANCE FROM FRONT TO REAR AXLES:
(CENTER OF STEERING AXLE TO CENTER OF EXTREME REAR AXLE)
(2) LIENHOLDER NAME:
STREET ADDRESS:
CITY / STATE / ZIP CODE:
DATE OF LIEN:
EXCEPT AS AUTHORIZED BY LAW, THE DMV WILL NOT DISCLOSE PERSONAL INFORMATION
WITHOUT YOUR CONSENT.
DO YOU CONSENT TO SUCH A DISCLOSURE?
OWNER’S SIGNATURE:
DATE:
SECOND OWNER’S SIGNATURE:
IF CORPORATION, GIVE TITLE OR POSITION:
IF MINOR, SIGNATURE OF PARENT OR GUARDIAN:
NOTARY PUBLIC SIGNATURE:
NOTARY PUBLIC NAME:
DATE:
COMMISSION EXPIRATION DATE (MANDATORY):
APPLICATION FOR REGISTRATION
AND TITLE CERTIFICATE (TR-1)
STATE OF RHODE ISLAND – DIVISION OF MOTOR VEHICLES
600 New London Avenue, Cranston, RI 02920-3024 Phone: 401-462-4368 www.dmv.ri.gov
rev.10/2017
OWNER’S SIGNATURE MUST BE NOTARIZED IF NOT PRESENT DURING TRANSACTION
PHONE #:
CC
A. BUYER, NEW OWNER, OR LEASING COMPANY’S INFORMATION
SECOND OWNER INFORMATION, IF APPLICABLE
TAX & TITLE
(complete sections A,B*,E,F*,H)
YES NO
LAST NAME (OR COMPANY NAME): PHONE #:
FIRST NAME:
