MV-1 (Revised 10-2018)
Georgia Department of Revenue - Motor Vehicle Division
Form MV-1 Motor Vehicle Title Application
For instructions on how to complete this form, please see Instructions on page 2.
A
VEHICLE INFORMATON
Vehicle ID (VIN): _____________________________ Current Title # ____________________________ Year: _______
Make: _____________________________ Current Title’s State of Issue: _________________ Color: _______
Model: _____________________________ GA County of Residence: _________________ Cylinders: _______
Body Style: _____________________________ District # _____________________________ Fuel Type: _______
Odometer exceptions: EXEMPT Exceeds Mechanical Limits of Odometer Not the Actual Mileage, Warning Odometer discrepancy
Odometer Reading: _____________________________ Date Purchased: _____________________________
COMPLETE FOR ALL COMMERICAL VEHICLES
Gross Vehicle Weight & Load: __________________________ Straight Truck? Yes No Used for Hire? Yes No
Type of Trailer Pulled? _____________________ Product Hauled? ____________________ Is this a Farm Vehicle? Yes No
B
OWNER INFORMATION
Number of Owners: _______ Leased Vehicle: No Yes (If yes, complete Section D)
If purchased from an out-of-state business, did you pick up the vehicle out-of-state? Yes No
*Owner’s signature below warrants: I do solemnly swear or affirm under criminal penalty of a felony for fraudulent use of a false or fictitious
name or address or for making a material false statement punishable by fine up to $5,000 or by imprisonment of up to five years, or both that
the statements contained herein are true and accurate.
OWNER # 1
Full Legal Name: _____________________________________________ Driver’s License # ___________________ State: _____
Date of Birth: ___________ Email Address: _________________________________________ Phone # __________________
Business Name: ____________________________________________ Name of Agent: _________________________________
Address: ______________________________________________________________________________________________
Mailing Address: ________________________________________________________________________________________
*Signature of Owner 1 or Business Agent: _________________________________________________ Date: ________________
OWNER # 2
Full Legal Name: _____________________________________________ Driver’s License # ___________________ State: _____
Date of Birth: ___________ Email Address: _________________________________________ Phone # __________________
Business Name: ____________________________________________ Name of Agent: _________________________________
Address: ______________________________________________________________________________________________
Mailing Address: ________________________________________________________________________________________
*Signature of Owner 2 or Business Agent: _________________________________________________ Date: ________________
C
SELLER INFORMATION
D
LESSEE INFORMATION
Driver’s License Number, if individual:
______________________________________________
Lessee’s Full Legal Name & Address or Business Lessee’s Full Name &
Address:
___________________________________________________
___________________________________________________
___________________________________________________
Lessee’s GA County Name: ______________________________
Lessee’s Phone Number: ______________________________
D
SECURITY INTEREST OR LIENHOLDER INFORMATION (Attach any information on additional lienholders)
12 Digit ELT ID # __ __ __ __ __ __ __ __ __ __ __ __ Name: ______________________________________________
Address: ______________________________________________________________________________________________
12 Digit ELT ID # __ __ __ __ __ __ __ __ __ __ __ __ Name: ______________________________________________
Address: ______________________________________________________________________________________________
F
ATTORNEY IN FACT INFORMATION Attach original power of attorney if title is to be mailed to attorney-in-fact.
Name: ______________________________________________________________________________________________
Mailing Address: ________________________________________________________________________________________
Phone Number: ___________________________ Email Address: _________________________________________________
1FTNE24L56HB43432
FORD
ECONOLINE E250
VN
COBB
2006
WHITE
8
05/02/2020
0
GASOLINE
8,600
1
ROSSANO, TAMI LAUREN
050472707
GA
10/26/1978
4119 MCEVER WOODS DR NW
ACWORTH, GA 30101-6672
,
0 0 1 1 0 5 5 8 9 5 7 8
,
MARIETTA CAR CENTER (ROSWELL)
843 ROSWELL STREET NE, MARIETTA, GA 30060
COBB
0 0 1 1 0 5 5 9 6 1 7 7
MARIETTA CAR CENTER
843 ROSWELL ST NE, MARIETTA, GA 30060-2136
9127559457
Georgia Department of Revenue - Motor Vehicle Division
Form MV-1 Motor Vehicle Title Application
INSTRUCTION PAGE
Purpose of this Form: This form is to be used when applying for a tag and title and must be signed by all owners in Section B.
How to submit this Form: This form must be completed in its entirety, legibly printed or typed, and submitted along with all required
document(s) to the county tag office in the county where you reside or to the Department of Revenue (DOR), when applicable. Please refer to
http://dor.georgia.gov to locate the county tag office in your county of residence.
A
VEHICLE INFORMATON
This section must be completed in its entirety. If you do not know the district in which you live, please check with your County Tag Office.
Include all the requested information: Vehicle Identification Number (VIN), Make of vehicle, Model of vehicle, Current Title number, Current
Title’s State of Issue, Georgia County of Residence, District # (if known), Year of vehicle, Color, Cylinders of vehicle, Body style, Fuel Type,
and Odometer information including: whether exempt, exceeds mechanical limits, not actual mileage.
Also include Odometer reading and date purchase.
COMPLETE FOR ALL COMMERICAL VEHICLES
This section must be completed for all request concerning a commercial vehicle.
B
OWNER INFORMATION
List the number of owners, whether the vehicle is leased, and if it was purchased out-of-state.
All owners listed on the title must sign this form. By signing this form you are agreeing to the following:
*Owner’s signature below warrants: I do solemnly swear or affirm under criminal penalty of a felony for fraudulent use of a false or fictitious
name or address or for making a material false statement punishable by fine up to $5,000 or by imprisonment of up to five years, or both
that the statements contained herein are true and accurate.
OWNER # 1
For Owner number one:
If a business, provide the business name, the name of the signee, address, mailing address (if applicable), email address, and
telephone number.
If an individual, provide the driver’s license number, state of issuance, full legal name, date of birth, address, mailing address (if
applicable), email address, and telephone number.
Signature is required.
OWNER # 2
For Owner number two:
If a business, provide the business name, the name of the signee, address, mailing address (if applicable), email address, and
telephone number.
If an individual, provide the driver’s license number, state of issuance, full legal name, date of birth, address, mailing address (if
applicable), email address, and telephone number.
Signature is required
C
SELLER INFORMATION
D
LESSEE INFORMATION
Provide:
Lessee’s driver’s license lumber (if individual),
Lessee’s Full legal name and address or Business Lessee’s
full name and address, and
Lessee’s Georgia County name
Lessee’s phone number
D
SECURITY INTEREST OR LIENHOLDER INFORMATION (Attach any information on additional lienholders)
List the following for the first two security interest or lienholders (attach any additional lienholder information to this form)
12 Digit Customer ID #
Name
Address
F
ATTORNEY IN FACT INFORMATION Attached original power of attorney if title is to be mailed to attorney-in-fact.
If using a Power of Attorney, attach the Power of Attorney and fill in their:
Name
Mailing Address
Phone Number
Email Address
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