Title and Registration Bureau
Statement of Fact
Only
The Statement of Fact (form MV100) may be used for the purpose of a:
• No interest statement
• Cancellation of sale statement
• Letter of consent
• Relinquishment statement
• Statement of error
• No security interest or lien to file statement
• Request to update customer record residential/mailing address
• Special mailing authorization (titles will be mailed to out-of-state addresses only)
• Legal signature statement
• Letter of explanation
• One and the same statement*
Printed name of person making statement and name of firm or corporation
Vehicle/Vessel Identification No:
Statement
* Indicate how name is to be entered on the Title:
Under penalty of law (MCA 45-7-203), I certify that the statements made and information contained on this form are
true and correct to the best of my knowledge, information, and belief; I am the person named on this form; and, if
signing for a business entity or trust, I have full authority to do so.
Signature _____________________________________________________________________ Date ________________________
This is my legal signature
Printed name _______________________________________________________________________________________________
Montana county and state authorities reserve the right to reject any form that has been altered.
MV100 (9/16) This form is available in alternate formats for people with disabilities.
P.O. Box 201431, 302 N Roberts, Helena, MT 59620-1431
Phone (406) 444-3661 Fax (406) 444-0116 mvdtitleinfo@mt.gov
