Fillable Application For Registration Title And Security Interest 2018 (Scott County Iowa)

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Application For Registration Title And Security Interest 2018 (Scott County Iowa)

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The Application For Registration Title And Security Interest 2018 (Scott County Iowa) form is 2 pages long and contains:

  • 3 signatures
  • 94 check-boxes
  • 104 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Scott County Iowa

BROWSE SCOTT COUNTY IOWA (IA) FORMS

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08/2018 cmc IOWA DEPARTMENT OF NATURAL RESOURCES DNR Form 542-8067
Title #:
APPLICATION
Registration # (IA #):
REGISTRATION
─ Owner Information ─ The 1
st
applicant will be listed as the primary owner shown on the registration.
If a Business/Trust: Use Entity Name as Full Name, Date of Inception as Birth Date, and Tax ID Number/FEIN as SSN.
Required
Iowa Resident
#1 Full Name:
Birth Date:
Address:
City/State/Zip Code:
DNR Number:
DL Number:
Social Security Number:
If sent electronically leave blank.
Gender:
Male Female
Height:
Weight:
Eye Color:
Phone:
Email:
Iowa Resident
Nonresident
#2 Full Name:
DL Number:
Birth Date:
Address:
City/State/Zip Code:
Gender:
Male Female
Height:
Weight:
Eye Color:
Iowa Resident
Nonresident
#3 Full Name:
DL Number:
Birth Date:
Address:
City/State/Zip Code:
Gender:
Male Female
Height:
Weight:
Eye Color:
All owners can be listed as
And- requires all parties to sign upon sale, title or transfer
Or- requires one party to sign upon sale, title or transfer
APPLICATION DATE:
COUNTY OF REGISTRATION:
IOWA APPLICATION FOR:
1 BOAT
2 ATV
3 SNOW
4 ORV
5 ORM
TYPE:
6 New Number/Registration
8 Duplicate
10 Renewal of Number
12 Transfer of Ownership
14 Other
7 Title
9 Duplicate Title
11 Bond
13 Lien
15 Subsequent Lien
BOAT
Previous Title No (if any):
Registration No (if any):
Boat Name:
Port Name:
Make
Model
Homemade
State of Primary Operation:
Color
Model Year
Overall Length
Boat Width
HIN
FT.
IN.
FT.
IN.
Primary Operation:
1 Pleasure
2 Dealer or
Manufacturer
Demonstration
3 Rent or Lease
4 Official
5 Commercial
Passenger
Carrying
6 Commercial
Fishing
7 Other Commercial
Operation
8 Charter Fishing
Vessel Type:
1 Cabin Motorboat
2 Paddlecraft/Canoe
3 Personal
Watercraft
4 Houseboat
5 Pontoon
6 Rowboat
7 Open Motorboat
8 Sail Only
9 Other:
10 Paddlecraft/Kayak
11 Auxillary Sail
12 Air Boat
13 Inflatable Boat
Hull Material:
1 Aluminum
2 Fiberglass
3 Wood
4 Steel
5 Plastic
6 Other:
7 Rubber/
Vinyl/ Canvas
Propulsion Type:
1 Propeller
2 Water Jet
3 Sail
4 Manual
5 Air Thrust
6 Other:
Engine Drive Type:
1 Inboard
2 Outboard
3 Pod Drive
4 Sterndrive
5 Other:
6 None
Fuel:
1 Gas
2 Diesel
3 Other:
4 Electric
Capacity (from plate, if
any): persons
Horsepower:
h.p.
Toilet
Yes No
ATV/SNOWMOBILE/ORM/ORV
Electric
DOT Titled
Previous Title No (if any):
Registration No (if any):
Make
Color
Model
VIN
Antique Snowmobile
Model Year:
CC:
Dry Wt. in Lbs:
No. of Wheels:
(OVER FOR TITLING, DEALER SALES INFORMATION, BONDING, AND SIGNATURES)
08/2018 cmc IOWA DEPARTMENT OF NATURAL RESOURCES DNR Form 542-8067
COUNTY RECORDER USE ONLY:
1 Transfer Without
4 Tax Paid Dealer
7 Casual Sale
9 No Exemption
Consideration
5 Tax Paid Other State
8 Other
10 Tax Exempt
2 Homemade
6 Purchase for Resale
3 Government, Nonprofit
SELLER
Name
Address
Purchase Date
EVIDENCE OF OWNERSHIP
I present the following
evidence of ownership:
Manufacturer’s Statement
Operation of Law Affidavit
Foreign Title Certificate
Specially Constructed/Homemade
Reconstructed/Rebuilt
Registration Certificate
LIEN/SUB LIEN
Does this vehicle/vessel have a lien? Yes No
1
st
Lienholder
Street Address
City/State/Zip
2
nd
Lienholder
Street Address
City/State/Zip
BOND (Use this section only if you have purchased a bond)
Book Value:
$
(can be obtained from an Iowa registered dealer or current NADA value.)
Bond Amount:
$
(minimum of 1 1/2 times book value)
Dealer No.
Dealership Name
Dealership Signature
I have visually examined this vehicle/vessel and have checked for wants/stolen.
Officer Signature:
Date:
Iowa DNR
DEALER USE ONLY:
Sale Price $
Registration Fee Collected $
Date Acquired:
Less Trade-In $
Sales Tax Collected $
Equals Tax Price $
Tax Previously Paid $
I certify under penalty of perjury that the foregoing is true and correct.
DNR Dealer No.
Dealership Name
Dealership Signature
SIGNATURES
Important: Be certain that dates and other information given are correct. Any person who uses a false or fictitious name, makes a
false statement or otherwise commits a fraud upon this application is punishable by imprisonment and possible fine per Iowa
Code Section 462A.23.
I attest that the Hull Identification Number (HIN) or Vehicle Identification Number (VIN) is correct and permanently affixed to the vessel or vehicle for
which I am making application. I have reviewed all information above and acknowledged that it is accurate and true.
Signature of: Owner/ Security Holder #1:
Date:
Signature of: Owner/ Security Holder #2:
Date:
Signature of: Owner/ Security Holder #3:
Date:
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Application For Registration Title And Security Interest 2018 (Scott County Iowa)

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Completed 14 February 2021

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