445 Minnesota Street,Saint Paul, MN 55101-5185
Phone: (651) 297-2126 TTY: (651) 282-6555
dvs.dps.mn.gov
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
Application for Transfer-on-Death Beneficiary
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DL/ID Number:
Owner 1: Last, First, Middle Date of Birth:
PS2004-2 Rev. 09/2017
B. Designation of Transfer on Death Beneficiary (When the beneficiary is a person)
Page 1 of 2
A. Owner Information
C. Designation of Transfer on Death Beneficiary (When the beneficiary is an entity)
ZIP CODESTATE
CITY
STREET ADDRESS
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DL/ID Number:
Owner 2 (If applicable): Last, First, Middle Date of Birth:
ZIP CODESTATE
CITY
STREET ADDRESS
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DL/ID Number:
Beneficiary Information: Last, First, Middle Date of Birth:
ZIP CODESTATE
CITY
STREET ADDRESS
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DL/ID Number:
Owner 3 (If applicable): Last, First, Middle Date of Birth:
ZIP CODESTATE
CITY
STREET ADDRESS
1. Owner Information: Complete the owner information, listing all owners name, address, date of birth and driver license or
identification card number.
2. Beneficiary Designation: Complete the beneficiary designation including name, address, date of birth and driver license or
identification card number. If the beneficiary is an entity the name and address is required.
3. Motor Vehicle Information: Complete the motor vehicle information.
4. Spousal Consent: If required, complete the spousal consent (Section E) and have the signature notarized.
5. Vehicle Owner Acknowledgment: Read and initial all of the owner acknowledgement statements and sign and have the
signature notarized.
6. Application for Title: The Transfer on Death Beneficiary designation is not a title application. You must complete and
include the Application for Motor Vehicle Title, PS2000 with the Transfer on Death designation.
Instructions
ZIP CODESTATE
CITY
STREET ADDRESS
Beneficiary Information: Entity name
Important Notes: DVS recommends the vehicle owner should keep a copy of this beneficiary application with other important documents. A
motor vehicle title will not be provided to the beneficiary. Ownership of the vehicle will transfer to the beneficiary upon the death of the owner
or the last survivor of joint ownership with rights to survivorship, subject to the rights of secured creditors. To remove a beneficiary, you must
apply for a new title. Please be aware that Driver and Vehicle Services cannot provide legal or estate planning advice; please see a licensed
attorney.
Reference: Minnesota Statute Chapter 168A.125.
