THIS APPLICATION IS FOR A DUPLICATE (Please check one):
Check the box that indicates why the document must be replaced:
Temporary Address:
Attach a SELF-ADDRESSED, STAMPED ENVELOPE if the document must be sent to a temporary address, and print that address here:
Please Check One:
I certify that all of my declarations are true and correct. I am the owner or secured party of this vehicle and the original document has not been assigned and/or
surrendered to anyone.
X X
APPLICANT(S) SIGNATURE(S) APPLICANT(S) SIGNATURE(S)
LIEN RELEASE – Print name and address of lien holder
Subscribed and sworn to before me
SECURED PARTY’S NAME
- NOTICE -
STREET ADDRESS MINNESOTA TAX ID NO.
Secured party’s signature
must be notarized to release
a lien.
CITY STATE ZIP CODE
SIGNATURE AND TITLE OF AUTHORIZED AGENT
The secured party named no longer
claims a security interest in the vehicle
described above.
Date of Release:
this
Day of 20
NOTARY PUBLIC
COUNTY
MY COMMISSION EXPIRES
INSTRUCTIONS: PLEASE READ CAREFULLY BEFORE COMPLETING
1.
Duplicate plates and stickers ARE NOT required when applying for a duplicate title, registration/cab card or lien card. You only need to complete this side of the form.
2.
Fees: Please contact DVS or your local deputy registration to determine fees or for assistance in completing this form. If you are applying by mail, make remittance payable to:
Driver and Vehicle Services.
IMPORTANT NOTICE: PLEASE READ
DVS will issue a duplicate certificate of title only to the owner or legal representative (power of attorney is required) of the owner named on the original certificate. If the original certificate of
title is recovered, it must be returned to DVS.
All data collected on a motor vehicle application are required by law. These data are used to identify your motor vehicle. Failure to provide required data may result in denial of the
transfer of ownership, registration of this vehicle, or other requested action. Except for certain uses permitted by federal and state laws, personal information contained in your
application may not be disclosed to anyone without your express consent.
PS2067A-18 (11/17)
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
DRIVER AND VEHICLE SERVICES
445 Minnesota Street Saint Paul, MN 55101-5187
Phone: (651) 297-2126 TTY: (651) 282-6555 Web: dvs.dps.mn.gov
APPLICATION FOR DUPLICATE TITLE, REGISTRATION, CAB OR LIEN CARD
PLEASE READ THE INSTRUCTIONS AT THE BOTTOM OF THIS PAGE BEFORE COMPLETING
Duplicate plates and stickers ARE NOT required when applying for duplicate title
X
Cab Card Lien CardReg. CardTitle
DESTROYED
LOST
GIVEN TO BUYER (SELLER IS FILING AFFIDAVIT OF SALE)
NOT RECEIVED (Your lending institution or the postal service may have the missing document)
ILLEGIBLE – Attach the illegible document
MUTILATED – Attach the mutilated document
TITLE NUMBER OF MISSING DOCUMENT
VEHICLE IDENTIFICATION NUMBER
MN PLATE NUMBER MAKE MODEL YEAR
FOR CENTRAL OFFICE USE ONLY
FOR OFFICE USE ONLY
DRIVER'S LICENSE NUMBER DATE OF BIRTHLAST, FIRST, MIDDLE NAME
PRINT
APPLICANT'S
FULL NAME
FIRST
OWNER
ADDITIONAL
OWNER
u
DATE OF BIRTHDRIVER'S LICENSE NUMBERLAST, FIRST, MIDDLE NAME
u
FEES DUE
PRINT ADDRESS OF
FIRST OWNER
(PERMANENT ADDRESS)
ZIP CODESTATECITYSTREET ADDRESS COUNTY
ZIP CODESTATECITYSTREET ADDRESS
STOLEN
Title of Agent if Applicant is Secured Party:
Date
DUPLICATE
FILING
TOTAL
Applicant is the Owner (if jointly owned, only one owner's signature is required) Applicant is Secure Party
