Fill - Free fillable Instructions How To Complete This Application (Bad River Band Of Lake Superior Tribe Of Chippewa Indians) PDF form

Information Regarding Title to Lien Holder

On July 30, 2012, Wisconsin became a title to lien holder (lender) state. Any title with a lien (loan) listed as of July 30, 2012,

will be sent to the lien holder rather than the owner. Owners of vehicles will receive a Conrmation of Ownership and will

receive the actual title when all liens are paid o. Vehicle owners are not eligible to apply for a replacement title until

that time. Contact your lender for the title.

● Customers may apply for a replacement title for vehicles that are currently titled in their name. This excludes any

vehicles titled after July 30, 2012, with a lien listed. Titles with liens issued after this date will only be issued to lien

holders. To check for lien information on your vehicle, refer to online services at: wisconsindmv.gov.

● Lien holders who received an electronic title cannot apply for a replacement using the MV2119, they must contact

their service provider for assistance.

Instructions – How To Complete This Application

IF QUESTIONS: Call (608) 264-7447 or contact the DMV Customer Service Center nearest you.

For a list of title and registration locations, visit http://wisconsindmv.gov/Pages/online-srvcs/external/dmv.aspx.

To replace a lost or damaged Wisconsin title, complete Sections A though F as they apply.

If you are the lien holder who received the original title for this vehicle, please complete the Vehicle Lien Holder Certication section.

SECTION

Vehicle Owner Information

Owner/Co-owner: The names on the replacement title

will match what is currently in our records. “And” means

all owners must sign the title to transfer ownership.

“Or” means only one owner must sign the title.

Opt Out: You may remove your name(s) from mailing

lists that contain 10 or more individual names by checking

the box. Businesses are not eligible for opt out.

Social Security Number and Driver License Number:

If you are applying as an individual, you are required

to provide your Social Security Number (SSN), under

s.342.06(1)(eg) Wis. Stats. If you have a WI driver

license, you may provide that number instead of your

SSN. Under the Social Security Act, 42 USCs. 405,(c)

(2)(C) (i), the department and other state and federal

agencies may use the SSN for purposes authorized by

law. FEIN: Federal Employer Identication Number is

required for corporations or other non-individual owners.

Vehicle Information

The vehicle identication number and plate number

are necessary to process your application.

Loan Information: For any new loans you

may be adding, contact the lender for the correct

information, including complete mailing address.

You will receive a Conrmation of Ownership and

your title will be sent to the rst lender on the title.

If you are listed on the Department of Children and

Family Services (DCF) docket for unpaid child support,

the title will be delivered to their oce (if there are

no other liens on the vehicle) and you will receive a

Conrmation of Ownership. If you have questions

about child support, contact DCF at: (608) 267-3905.

Fees

Replacement Title Fee is required to replace a

lost, stolen or mutilated Wisconsin title.

Loan Filing Fee is required if you are adding a new loan to

the vehicle at the time of application for a replacement title.

Counter Service Fee is required if you apply in

person at a DMV Customer Service Center.

Processing Fee may be required if you are adding a loan and

the Secured Party is not ling electronically; add $5 for DMV

processing. Nonexempt Secured Parties must pay an additional

$20 surcharge that may not be charged to the customer.

 VehicleOWNERCertication

Only the owner may apply for a replacement title if there are no

liens on the vehicle or the lien was led before July 30, 2012.

Complete the permission to mail title certication section if the

replacement title should be sent to someone other than the

vehicle owner name and address shown above in section A.

 VehicleLIENHOLDERCertication

Only the lien holder may apply for the replacement title if the

lienwasledonorafterJuly30,2012. Lien holders who

received an electronic title cannot apply for a replacement using

this form. They must contact their service provider for assistance.

Complete the name and address section if the replacement

title should be sent to someone other than the lien holder.

Release of Non-Exempt Information: Under Wisconsin

open records law, the Wisconsin Department of Transportation

must provide information from its records to requesters. If you

do not want your name and address included in requests we

receive for ten or more records, you may ask the department

to withhold your name and address from those lists. Form

MV3592 is available at DMV Customer Service Centers and

at: http://wisconsindot.gov/Pages/global-footer/formdocs/

default.aspx.

ADA: The Wisconsin Department of Transportation

complies with the Americans with Disabilities Act.

REPLACEMENT TITLE APPLICATION

MV2119  11/2017 Pursuant to s.342.13 Wis. Stat. Wisconsin Department of Transportation

Go to Application

DO NOT WRITE ABOVE THIS LINE. Complete form using BLUE or BLACK INK.

Usethisformifyouarereplacingalost,stolen,ormutilatedtitle.

See the instructions for more information. If this is a Transfer of Ownership, please use form MV1 – Title/License Plate Application.

REPLACEMENT TITLE APPLICATION

Wisconsin Department of Transportation

MV2119  11/2017 s.342.13 Wis. Stat

Section E – Vehicle OWNERCertication

(Owner Signature) (Date – m/d/yyyy)

(Co-owner Signature) (Date – m/d/yyyy)

Replacement Title Fee – $20 $

Loan Filing Fee – $10 (pay fee for each loan in Section C) $

Counter Service Fee – $5 (if you apply in person at WisDOT) $

Processing Fee – ( if applying thru an agent that les electronically

an additional fee will be charged) $

ENTER FEE TOTAL $

MAIL the application and check to:

WI Dept. of Transportation

POBox7949,MadisonWI53707-7949

Make Check Payable To: Registration Fee Trust

Section D – Fees

Vehicle Identication Number (standard VIN has 17 characters)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Year Make Type (Car, Truck, Van, etc.) Color Fleet No. (Optional)

License Plate Number

1 2 3 4 5 6 7 8

Vehicle is kept in County City Village Town (check one)

OF:

  

OF:

Section B – Vehicle Information

By signing below, I (we) certify that my (our) title is lost, stolen or

mutilated and is not currently held by the lien holder. The information

and statements on this application are true and correct.

PermissiontoMailTitleCertication

If you would like the title mailed to a dierent address, please ll in

the name and address below. I, the owner of the above vehicle, give

permission to mail the replacement title to the following:

Name of Title Recipient

Address of Title Recipient

City State ZIP Code

Section F – VehicleLIENHOLDERCertication

Wisconsin titles issued electronically to the lien holder cannot be

issued a paper replacement title. See reverse side for more information.

By signing below, we certify that we are requesting the title on

our behalf as the current holder of this title and statements on

this application are true and correct.

Did you... Enclose a signed check? Sign the application?

Make a copy for your records?

STOP

Name of Lending Agency(s) or Person(s)

Street Address (include PO Box if applicable)

City State ZIP Code

Secured Party Number (Area Code) Telephone Number

If you would like the title sent to a dierent address, please ll in the

name and address below. We, the lien holder of the above vehicle, give

permission to mail the replacement title to the following:

Name

Address

City State ZIP Code

Any title with a lien (loan) listed as of July 30, 2012, will be sent to the lien

holder. Please visit http://wisconsindot.gov/Pages/online-srvcs/other-

servs/lien-search.aspx to verify lien list dates.

(Lien Holder Signature) (Date – m/d/yyyy)

Section A – Vehicle Owner Information

Section C – Loan Information — Use this section if you are adding a new lien

Name of Lending Agency(s) or Person(s) Secured Party Number(s)

1 2 3 4 5 6 7 8

(Area Code) Telephone Number

Street Address (include PO Box if applicable) City State ZIP Code

Title No. – New License Plate No.

Amount Received – Document No.

Check Cash

Processor ID No. Received – Date – Opened

Owner Legal Name (Last, First, Middle Initial OR Business Name)



Opt Out regarding open records laws (see instructions)

Birth Date

M M D D Y Y Y Y

Owner Social Security Number – Required

1 2 3 4 5 6 7 8 9

Driver License Number – Required

1 2 3 4 5 6 7 8 9 10 11 12 13 14

FEIN Number (if company owned) – Required

1 2 3 4 5 6 7 8 9

Co-Owner Name (if any) (Last, First, Middle Initial)

(check one)



AND

Birth Date

M M D D Y Y Y Y

Co-Owner Social Security # or Driver License # or FEIN Number – Required

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Street Address (include PO Box if applicable) City State ZIP Code Owner Daytime (Area Code) Telephone Number

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