1 DMV-5-TR REV 11/12 West Virginia Department of Transportation Division of Motor Vehicles 1-800-642-9066 v.go v www .dm v.w Adavit of Transfer of Ownership Without Consideration , do hereby transfer to a I, NAME OF NEW VEHICLE OWNER NAME OF CURRENT VEHICLE OWNER YEAR MODEL VEHICLE IDENTIFICATION NUMBER or no consideration, monetary or otherwise. I declare under penalty of false swearing that the f TITLE NUMBER statement made above is true and correct to the best of my knowledge and the transfer does not involve any exchange of goods, service or money in return for the vehicle. Certication of NEW Ownership Certication of CURRENT Ownership NAME OF NEW OWNER(S) NAME OF CURRENT OWNER(S) ADDRESS ADDRESS PHONE NUMBER LICENSE/ID NUMBER PHONE NUMBER LICENSE/ID NUMBER (X) (X) DATE SIGNATURE OF CURRENT OWNER(S) DATE SIGNATURE OF NEW OWNER(S) Certication by Notary Public NEW OWNER’S Certication by Notary Public CURRENT OWNER’S *ONLY ONE NOTARY CERTIFICATION IS REQUIRED IF BOTH CURRENT AND NEW OWNERS *THIS NOTARY SECTION IS TO BE USED ONLY IF THE CURRENT AND NEW OWNERS CANNOT SIGN ARE AVAILABLE AND PRESENT AT THE SAME TIME FOR NOTARY CERTIFICATION.* UNDER WITNESS OF THE SAME NOTARY AT THE SAME LOCATION AND TIME.* Subscribed and sworn to before me this __________ day of Subscribed and sworn to before me this __________ day of ___________________________ , 20_________ . ___________________________ , 20_________ . (X) (X) NOTARY PUBLIC NOTARY PUBLIC My commission expires on: _________________________________ My commission expires on: _________________________________ NOTARY STAMP NOTARY STAMP *ANY CHANGES, ALTERATIONS, OR ERASURES WILL VOID THIS AFFIDAVIT* ANY APPLICATION FOR TRANSFER OF OWNERSHIP WHICH PROVIDES INCORRECT, FALSE OR FRAUDULENT INFORMATION ABOUT THE CONSIDERATION EXCHANGED, SUBJECTS THE APPLICANT TO THE REVOCATION, SUSPENSION AND/OR CANCELLATION OF ANY AND ALL DRIVER’S LICENSES, REGISTRATION PLATES, CARDS, AND PERMITS ISSUED TO THE APPLICANT.
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