MVR 4 Front page

Transcript

1 MVR-4 5 8 ) North Carolina Division of Motor Vehicles (Rev. 0 online /1 .00 $ 20 Fee There is a 15-day mandatory waiting period after an application for duplicate title is received by the Division of Motor 7 can be NCDMV, 3148 Mail Service Center, Raleigh, NC 2769 of title -3148 . a certificate Vehicles before issued. Mail to: ____ VEHICLE DESCRIPTION Title No. __________________________________ ____ _______________ __ ____________ ____ Make ___________________ ___ Body Style __________________ _ Series Model Year _________ ____________________ Vehicle Identification Number _______ _________ __________________________________ _ Fuel Type _________ Name of Registered Owner(s) ________________________________________________________________________________ __________________________ Name Last Name First Name Middle ___________________________ ________________________________________________________________________________________________________ Residential Address City State Zip Code County Mailing Address __________________________________________________________________________________________ __ _________________________ (IF DIFFERENT FROM ABOVE) Vehicle Location Address ___________________________________________________________________________________ __________________________ (IF DIFFERENT FROM ABOVE) ON ORIGINAL TITLE LIEN RECORD AS SHOWN First Lien __________________________ ________________________________________________________________________________________________ Lien Holder A ddress Date ___________________________________ ___________________________________________________________ __________________________ Second Lien Lien Holder Date Address Third Lien _______________________________________________________________________________________________ ___________________________ Lien Holder Address Date DISCLOSURE SECTION licitation unless the block below is All motor vehicle records maintained by the North Carolina Division of Motor Vehicles will remain closed for marketing and so checked.  to be available for disclosure . I (We) would like the personal information contain ed in this application C CHECK APPLI ABLE BLOCK  Application for Duplicate Certificate of Title and Assignment by Registered Owner Application for Duplicate Certificate of Title as Recorded  Application for Duplicate Cert ificate of Title and Removal of Lien  If original title was issued subject to a lien and it has been satisfied, lien holder must certify to that effect. I (we) , the registered owner(s) of the above described vehicle, hereby make application for a duplicate certificate of title and certify that the original has been:   Lost Never Received (Check applicable block) al title to the Division of Motor Vehicles I understand that upon issuance of the duplicate, the original title becomes void and that I am required to return the origin immediately should it be found. Current Odometer Reading I (we) certify that the information on the application is correct to the best of my (our) knowledge. Signature(s) of registered owner(s) _____________________________ _______________________________________________ _________________________ State Date ______________________________ ____________ ____________________________ County _____________________________ _____________ I certify that the following person(s) personall y appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated: _______________________________ _____________ ___ _______________(name(s) of princip al(s)). Notary Printed Notary Signature or Typed Name ____________________ ________________________ ______________ ________________________________________________ (SEAL) My Commission Expires ____________________________________ AFFIDAVIT OF FIRST LIEN HOLDER I we ) , support the application for a duplicate certificate of title covering the above described vehicle and certify that the original title was: ( (CHECK APPLICABLE BLOCK)  Title lost while in my possession; lien has been satisfied  Lost while in my possession  Never Received  Surrendered to _________________________________________________ upon payment of lien in full. Lien holder’s signature by: ___________________________________________________________________ ___________________________ ______________________________ County ________________________________________ State Date ___________ ________________________________ I certify that the following person(s) personally appeared before me this day, each acknowl edging to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated: ______________________________________________________________( name(s) of principal(s)). Notary Notary Printed ________________________ Signat ure ________________________________________________ ______________ or Typed Name ____________________ (SEAL) ____________________________________ My Commission Expires duplicate title will be issued subject to such liens as were recorded on the last title and mailed to the first lien holder of record, unless lien release is submitted. The The lien holder may apply for a duplicate title, without the signature(s) of the registered owner(s), if the original title was lost while in the lien holder’s possession. When a title, mailed to a lien holder by the Division of Motor Vehicles, is not received, affidavits by the registered owner(s) and lien holder(s) are required in order to obtain a duplicate title.

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