AFTAB PUREVAL, CLERK OF COURTS
- HAMILTON COUNTY, OHIO
On the web - www.courtclerk.org
APPLICATION(S) FOR CERTIFICATE OF TITLE TO A MOTOR VEHICLE
CHECK TYPE OF APPLICATION(S) Fee of $5.00 for failure to apply for title within 30 days of assignment.
Applicant’s Name SSN/EIN
Applicant’s Address
hereby declares under penalty of perjury that he/she is the lawful (owner / purchaser / lienholder) of the following described motor
vehicle and hereby makes application(s) for the following:
VIN
BODY TYPE
PURCHASE
PRICE $
GROSS
TAX $
Tax Exemption
Reason
YEAR
MODEL CONVERSION
TRADE IN
AMOUNT $
NET
TAX $
MAKE
MILEAGE
TAX
BASE $
CONDITION OF VEHICLE
(check only one)
{ }Good { }Fair { }Poor { }Wrecked
Tax Exemption
Number
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.
ORIGINAL CERTIFICATE OF TITLE MEMORANDUM CERTIFICATE OF TITLE
SALVAGE 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 liens, state “none”. If more than one lien, attach statement of all
additional liens.
Lienholder
Address
Dealer’s Permit Number: Vendor’s Number
DUPLICATE CERTIFICATE OF TITLE
Application 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.
Applicant’s signature x____________________________________ By x ________________________________
Sworn to and subscribed in my presence by ______________________________ this __________ day of _________________________, 20______
Seal
x_______________________________________________________________
My commission expires __________________________ , 20_________
(Clerk, Deputy Clerk of Courts - Notary)
TYPE OR PRINT IN INK
HAM CTY / REV 03/09
Title
HAMCTY APPL 4/1/02 4:45 PM Page 1
