1-800-642-9066 • dmv.wv.gov
DMV Insurance
PO Box 17020 • Charleston, WV 25317
DMV-1-S
REV 08/19
West Virginia Department of Transportation
Division of Motor Vehicles
Sold Vehicle or Watercraft Notice
A) Owner/Seller’s Information • PRINT USING BLACK INK ONLY
B) Purchaser’s Information • If vehicle was sold to a salvage yard or junk dealer, list the name below as the buyer.
Name Daytime Phone
Address
STREET ADDRESS
COUNTY
CITY
STATE ZIP
ZIP
( )
Name Daytime Phone
Address
STREET ADDRESS
COUNTY
CITY
STATE
( )
C) Vehicle/Motorboat Information
D) Buyer/Seller Signatures
Make
Title Number
Year Date of Sale
Sale Price
Serial/VIN Number
SIGNATURE OF SELLER
(X)
DATE
/ /
SIGNATURE OF BUYER
(X)
DATE
/ /
SIGNATURE OF BUYER
(X)
DATE
/
/
SIGNATURE OF SELLER
(X)
DATE
/ /
I certify under penalty of law that the above information is true and accurate to the best of my knowledge.
**IF THE TITLE READS “AND”, BOTH SELLERS MUST SIGN. IF AVAILABLE, HAVE BOTH BUYERS SIGN.
**ANY PERSON WHO KNOWINGLY: MAKES A FALSE STATEMENT; CONCEALS A MATERIAL FACT; OR OTHERWISE COMMITS
FRAUD, IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A $1000 FINE, ONE YEAR IMPRISONMENT, OR BOTH.
**DO NOT USE THIS FORM, if you have junked the vehicle.
**If the sale date is unknown, list the approximate price.
**This notice will not be accepted if any lines are left blank.
* If the buyer’s name is unknown, list name as “UNKNOWN”.
$
/ /
click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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