STATEMENT TO REGISTER
A VEHICLE UNDER TITLE 38
NAME:
ADDRESS:
I certify that I am a disabled veteran of the armed forces of the United States, that I am qualified for and
have received the motor vehicle described below under the provisions of Title 38, US Code, Chapter 39,
and that I want to register the vehicle in New York State.
Year and Make of Vehicle:
Body Type:
Vehicle Identification Number:
Signature of Customer: X
TO BE COMPLETED AND SIGNED BY THE SELLER
I certify that the motor vehicle described above was obtained under the provisions of Title 38, US
Code, Chapter 39,
by
(Name of Person Obtaining the Vehicle)
through
(Name of Seller - Please Print)
______________________________________________________________________________________________________
(Signature of Seller)
X
MV-1E (8/15)
www.dmv.ny.gov