96-0561 R07/11 www.azdot.gov
I am the sole owner of the motor vehicle, described as follows:
Vehicle Identification Number Year Make
I designate that this vehicle be transferred, upon my death, to:
Beneficiary Full Legal Name (first, middle, last, suffix) Date of Birth (optional) Legal Status *
I release, discharge and agree to hold harmless, the Arizona Department of Transportation, Motor Vehicle Division
from any and all liability to anyone whomsoever which may arise by reason of any contest of the validity of the
beneficiary named herein.
This document is provided pursuant to Arizona Revised Statutes 28-2055(B) for the purpose of assigning a
beneficiary as named above.
Owner Name (first, middle, last, suffix) Owner Signature
Acknowledged before me this date.
Notary or MVD Agent Signature
Date County State Commission Expires
* Legal Status determines which signatures will be required to transfer ownership of the vehicle. Options are:
Or: Ownership is joint tenancy, with an expressed intent that either of the owners has full authority to
transfer ownership, license plates and/or fees, or to record loan information. Names will appear on the
title as in this example: JOHN DOE OR JOE ROSS
Signature of either party will be accepted. Both signatures are not required. All owners involved must sign
in the Legal Status box.
And: Ownership is tenancy in common. Names will appear on the title as in this example:
JOHN DOE AND JOE ROSS
Signatures of both parties will be required. In the event of the death of either party, the interest of the
deceased party must be handled by probate action, or by completing a Non-Probate Affidavit.
And/Or: Ownership is joint tenancy with right of survivorship. Names will be on the title as in this example:
JOHN DOE AND/OR JOE ROSS
Signatures of both parties will be required, if both are living. Upon proof of death, the survivor may sign
alone.
This form must be stapled to and presented with the current title,
and is
void if altered or erased.
BENEFICIARY DESIGNATION
For Vehicle Title Transfer Upon Death
