Text version of this Form
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I, __________________________________________ of ____________________________________________________
SELLER’S NAME SELLER’S ADDRESS
owner of the vehicle described below, in consideration of $___________________________. Receipt of which is hereby
SALE AMOUNT OF VEHICLE
acknowledged, do hereby transfer to ____________________________________________________________________
NEW OWNER/PURCHASER’S NAME
of _________________________________________________________. The following vehicle is a _________________
NEW OWNER/PURCHASER’S ADDRESS YEAR
________________________________ , with a vehicle identication number: ___________________________________.
MAKE AND MODEL VIN NUMBER
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief.
Signature of Seller (X)________________________________________________________ Date _____/_____/_________
Seller’s Phone Number ___________________________________ Seller’s Drivers License Number ___________________
Signature of New Owner (X)___________________________________________________ Date _____/_____/_________
New Owner’s Phone Number _________________________ New Owner’s Drivers License Number __________________
*AUDITS MAY BE PERFORMED ON CASUAL (NON-DEALER) MOTOR VEHICLE TITLE TRANSACTIONS.
N O TA R Y P U B L I C
Subscribed and sworn before me this _________ day of _________________________, 20_____.
NOTARY PUBLIC SIGNATURE
My Commission expires on ___________/____________/____________________
I M P O R TA N T N O T I C E
Any changes, alternations, or erasure will void this adavit.
The minimum taxable amount on vehicles is $500.00. A minimum taxable value of $100.00 applies to class T trailers, class R
travel campers, assembled vehicles or trailers, and vehicles purchased through welfare to work type programs.
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 drivers licenses’, registration
plates, cards, and permits issued to the applicant.