OS SS 52

Transcript

1 APPLICATION FOR DUPLICATE CERTIFICATE OF OWNERSHIP STATE OF NEW JERSEY MOTOR VEHICLE COMMISSION SPECIAL SERVICES P.O. BOX 017 TRENTON, NEW JERSEY 08666 -0017 (609) 292 -6500 EXT. 5074 ABOVE SPACE IS FOR OFFICE USE ONLY INSTRUCTIONS - PLEASE READ CAREFULLY 1. This form is to be completed by the titled owner(s) . Please type or print clearly. 2. ion certificate or A $60.00 check or money order (Do Not Send Cash) and a copy of the current or expired registrat insurance identification card must accompany the application t his information to the Trenton Central Office or . Mail ng in person to any motor vehicle agency along with Proof of Identity ( License ). bri Copy of Driver's 1. NAME OF TITLED OWNER -CORPCODE) OWNER'S NEW JERSEY DRIVER LICENSE NUMBER (IF BUSINESS DATE OF BIRTH EYE COLOR SEX ADDRESS CODE ZIP STATE CITY NO. AND STREET PH (CELL) (WORK) ONE: (HOME) WHERE DO YOU WANT THE TITLE MAILED (IF DIFFERENT THAN ABOVE ADDRESS) ? -OWNER: IF CO 1a. NAME OF CO -OWNER NEW JERSEY DRIVER LICENSE NUMBER EYE COLOR SEX DATE OF BIRTH ADDRESS DESCRIPTION OF VEHICLE YEAR BODY TYPE 2. LICENSE PLATE NO. MAKE MODEL WEIGHT CLASS COMPLETE VEHICLE IDENTIFICATION NO. 3. ARE THERE ANY ENCUMBRANCES OR LIENS AGAINST THE VEHICLE AT THIS PRESENT TIME? YES NO IF "YES", GIVE NAME AND ADDRESS OF LIENHOLDER and lienholder has not submitted evidence of satisfaction, a duplicate certificate NOTE : If the original certificate was issued subject to lien of ownership will not be issued until proof of payment is received from the lienholder. *If banks have merged it must be stated on Lien Release. E AGREEMENT AND (IF APPLICABLE) POWER OF ATTORNEY. *LIENHOLDERS MUST SUPPLY A COPY OF CONTRACT OR LEAS for a duplicate certificate of ownership, that a Chief Administrator 12... "A person who falsely states, in any application to the S. 39:10- R. re than ate of ownership, or title papers, are lost, shall be subject to a fine of not less than two hundred dollars ($200.00) nor mo certific five hundred dollars ($500.00) or imprisonment for a term not exceeding thirty days or both." because the whereabouts of the title paper This application is submitted to the Chief Administrator of the Motor Vehicle Commission in - owned by the undersigned IS UNKNOWN and certification is hereby made that it IS LOST . for the motor vehicle described here It is further certified that the YEAR MAKE IDENTIFICATION NO. VEHICLE was physically examined by me and the identification number is as entered hereon. I certify that I have compared this number with the a duplicate New Jersey Certificate of Ownership and they agree. numbers shown on the evidence of ownership and on my application for I further certify that I have read and understand this application and that all statements are correct. SIGNATURE OF TITLED OWNER SIGNATURE OF CO - OWNER DATE DATE (IF PARTNERSHIP, SO INDICATE, IF CORPORATION, GIVE TITLE OF OFFICER) if in a company name. OWER OF ATTORNEY *Need P IF NOT FILLED IN ENTIRELY AND ACCOMPANIED BY CHECK OR MONEY ORDER FOR $60.00 (DO NOT SEND CASH) THIS APPLICATION WILL BE REJECTED. 8 ) -52 OS/SS 2 /1 (R

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