MAIL TO: Receiving and Processing • PO Box 17710 • Charleston, WV 25317 • 1-800-642-9066 • www.dmv.wv.gov
DMV-4-TR
REV 6/17
West Virginia Department of Transportation
Division of Motor Vehicles
Adavit of Duplicate Title for a Vehicle or Watercraft
PRINT IN BLUE OR BLACK INK ONLY. THIS APPLICATION MUST BE ACCOMPANIED BY A COPY OF THE OWNER’S
DRIVER’S LICENSE. ENCLOSE A COPY OF YOUR REGISTRATION CARD IF AVAILABLE. IF LOST TITLE SHOWED A
LIEN RELEASE, SECTION D MUST BE COMPLETED. THERE IS A $15.00 FEE FOR YOUR DUPLICATE TITLE.
C.) Owner/Applicant Certication
D.) Discharge of Lien Holder(s)
A.)
Owner(s) Information
B.)
Vehicle/Watercraft Information
Select Reason for Requesting Duplicate (Check Only One):
Lost
Destroyed Never Received
Defaced
(attach defaced title)
Change of Address
The undersigned applicant, being duly sworn upon oath, deposes and says they are the owner of the vehicle/watercraft described herein:
I, the undersigned, swear or affirm that the information we/I have entered on this form is correct. I understand that making a false statement on this form may
constitute the crime of perjury. Furthermore, I agree to indemnify and hold harmless, the West Virginia Division of Motor Vehicles from any liability arising
from this transaction. I understand that the penalty for false statement in this application holds a fine of not more than $100.00 or imprisonment in the
county jail for thirty days, or both.
This application must be signed by the owner(s). If a person other than the applicant is signing this application, a power of attorney form is required.
SIGNATURE OF OFFICER TITLE
(X)
SIGNATURE OF NOTARY
/
(X)
/
COMMISSION EXPIRATION DATE
SIGNATURE OF APPLICANT OR LEGAL REPRESENTATIVE
(X)
SIGNATURE OF APPLICANT OR LEGAL REPRESENTATIVE
(X)
SIGNATURE OF OWNER
(X)
If the vehicle or watercraft has EVER had a lien against it, section D MUST be completed by the lien holder before a clear title can be
issued. If section D is not completed, the title will be mailed directly to the lien holder on record.
The undersigned, being a duly authorized agent for the lien holder, deposes upon his oath and says that the lien is discharged and the
lien holder has no interest in the above vehicle/watercraft.
Name of Lien Holder
VEHICLE OR WATERCRAFT OWNER NAME OF DEALERSHIP, LIEN HOLDER, OR INDIVIDUAL
I, to receive my duplicate title. hereby authorize
Address
This lien is fully paid, satised, and released this day of
, 20 .
E.) Release Adavit
Make
VIN or
Hull No
Body Style or
Hull Material
Plate or
Reg. No
Year
Vehicle Title
Boat Title
Name
Address
OWNER(S) NAME(S)
CITY
STATE ZIP
If the title reads “AND”, both owners signatures MUST appear. If signing for a company, indicate your title or position.
DIVISION USE ONLY • Veried in Computer:
$15.00
