CERTIFICATE OF TITLE/TEMPORARY REGISTRATION AND TAG APPLICATION
Please PRINT the information on this application.
A valid DC Driver License, DC Identification Card, DC Business License, DC Certificate of Occupancy, or a government issued document
showing DC Tax Identification Number must accompany this application; AND Power of Attorney for a Dealer Temporary Tag or Temporary
Registration.
One Year Registration Two Year Registration
One Year Registration with Residential Parking Permit (RPP) Two Year Registration with Residential Parking Permit (RPP)
APPLICANT INFORMATION (If a leased vehicle – provide the name of the Lessor and attach lease agreement)
OWNER/LESSOR FULL NAME (Last, First, Middle) DATE OF BIRTH STATE DRIVER LICENSE OR ID CARD #
BUSINESS NAME FEDERAL EMPLOYEE IDENTIFICATION #
JOINT OWNER(S)/LESSEE FULL NAME (Last, First, Middle)
(If vehicle is leased, the lessee’s name will not appear on the title)
DATE OF BIRTH DRIVER LICENSE OR ID CARD #
CURRENT ADDRESS (Address must match DC Driver License, DC Identification Card or DC Business License or state license for temporary tag)
ADDRESS UNIT/APT CITY/STATE ZIP CODE
EHICLE INFORMATION
MAKE
EAR BODY TITLE BRAND UNLADEN WEIGHT
EHICLE IDENTIFICATION NUMBER
ACTUAL MILEAGE
I certify to the best of my knowledge that actual mileage is__________________
LIEN INFORMATION (A Lien agreement must accompany this application. If a lien exists, the title will be mailed to the Lien holder)
LIEN DATE:
Name of Lien Holders Lien Holders Address Lien Amount
INSURANCE COMPANY INFORMATION (Current Proof of DC Insurance must accompany this application)
Name of Insurance Company Policy Number Policy Effective Date Expiration Date
I/we certify that the above information is true and correct to the best of my/our knowledge, information, and belief. Any person(s) using a fictitious name or address and/or
Knowingly making any false statements on this application is in violation of DC Law and subject to a fine of not more than $1,000 or 180 days imprisonment or both.
(DC Official Code § 22-2405)
Signature of Owner/Lessor: Date:
Signature of Joint Owner/Lessee: Date:
Signature of Joint Owner/Lessee: Date:
(Must be signed by Owner(s), Officer of Corporation or Partner in Partnership)
OFFICIAL DMV USE
EXCISE TAX SELLING PRICE (New Vehicles) NADA BUSINESS/FAIR MARKET VALUE (Used Vehicles)
$ $ $
TITLE # OR TAG# (HARD OR TEMPORARY)
pproval by DMV Examiner Date Operator’s Number
If you have questions, please visit our website www.dmv.dc.gov
or call 311 in DC or 202-737-4404 outside the 202 area code.
To report waste, fraud, or abuse by any DC Government Agency or official, call the DC Inspector General at 1-800-521-1639.
DMV-CTA-001 Rev. 08/15/2013
TYPE OF SERVICE
Temporary DC Registration New Title/New Tags New Title/Transfer Tags Title Only
Temporary Tag Salvage Title Non-Repairable Title Duplicate Title
Scrap/Junk Reciprocity (diplomat, military, student, etc.)
GOVERNMENT OF THE DISTRICT OF COLUMBIA
DEPARTMENT OF MOTOR VEHICLES
PO BOX 90120
WASHINGTON DC 20090
