DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
APPLICATION(S) FOR CERTIFICATE OF TITLE TO A MOTOR VEHICLE
(Type or Print in Ink)
CHECK TYPE OF APPLICATION(S) Fee of $5.00 for failure to apply for title within 30 days of assignment.
COUNTY
PRIMARY APPLICANT’S NAME SSN/EIN
PRIMARY APPLICANT’S ADDRESS
SECONDARY APPLICANT’S NAME SSN/EIN
SECONDARY APPLICANT’S ADDRESS
Hereby declares under penalty of perjury that he/she is the lawful (owner/purchaser/lien holder) of the following described motor vehicle and hereby
makes application for the following:
ORIGINAL CERTIFICATE OF TITLE
Evidence of ownership
MCO, Previous Title No., Registration, etc.
Applicant acquired said motor vehicle by (state how acquired)
from: Name of Previous Owner
Address of Previous Owner
The following is a full statement of all liens on said motor vehicle. If no lien state “none”, if more than one lien, attach statement of all additional liens.
Lien Holder
/E Code # Address
DUPLICATE CERTIFICATE OF TITLE
Appli
cant states that Certificate of Title Number
has been
;
that said motor vehicle has not been sold or disposed of except as stated below:
lost, stolen, destroyed
The vehicle is in the possession of
residing at
and that if said Certificate of Title be hereby
recovered by this applicant he will deliver same to the Clerk of Courts for cancellation.
The following is a full statement of all liens on said motor vehicle. If no lien state “none”, if more than one lien, attach statement of all additional liens.
Lien Holder
/E Code #
Address
REPLACEMENT CERTIFICATE OF TITLE for Certificate of Title Number
MEMORANDUM CERTIFICATE OF TITLE for Certificate of Title Number
SALVAGE CERTIFICATE OF TITLE
Applicant states that the original Certificate of Title Number
has been surrendered to the Clerk of Courts.
YEAR VIN MODEL
BODY TYPE MAKE CONVERSION
PURCHASE PRICE $ TRADE IN AMOUNT $ SALES/USE TAX $
VENDOR’S NUMBER PERMIT NUMBER SALES CREDIT AMOUNT $
CONDITION OF VEHICLE (Check only one)
GOOD FAIR POOR WRECKED
TAX EXEMPTION:
YES
REASON
Warning: You are required by law to state the true selling price. A false statement is in violation of section 2921.13 of the Ohio Revised Code and is
punishable by six months imprisonment and a fine of up to one thousand dollars or both. All transfers are audited by the Department of Taxation. The
seller and buyer must provide any information requested by the Department of Taxation. The buyer may be assessed any additional tax found to be due.
Applicant’s signature
X
Sworn to and subscribed in my presence by
this
day of
20
.
(Seal)
Clerk, Deputy of Clerk of Courts - Notary
X
BMV 3774 12/07
