Saturday, October 17, 2015

#COMMONWEALTH OF #KENTUCKY APPLICATION FOR TITLE AND REGISTERATION VTR

PPLICATION MUST BE COMPLETED IN BLUE OR BLACK INK
COMMONWEALTH OF KENTUCKY
APPLICATION FOR KENTUCKY CERTIFICATE OF TITLE/REGISTRATION
Check the type of application desired
If Duplicate is checked, the original Certificate of Title is:
Duplicate Title Only Transfer First Time Salvage Other
Lost Destroyed Damaged Illegible Other
Vehicle Identification Section
VIN Make
Year Body Style Model Model No. Color
Motor No. Cylinders Truck Weight
(if motorcycle)
TITLE BRAND DISCLOSURE
Check appropriate block if: Rebuilt Vehicle Water Damage
When block is checked and title does not include brand, provide
jurisdiction and title number
where previous brand was issued.
CERTIFIED INSPECTOR SECTION
I, (Certified Inspector)
O f County Phone No. ( )
Do certify under penalties that I have physically inspected the vehicle described
herein and that the supporting documents are consistent with the vehicle description.
THE VEHICLE HAS AN ODOMETER READING OF NO TENTHS
THE VEHICLE IDENTIFICATION NUMBER IS:
INSPECTION REQUESTED
BY
OWNER DRIVER LICENSE NO. & STATE
CERTIFIED INSPECTOR’S SIGNATURE INSPECTOR NO. DATE
ODOMETER DISCLOSURE **** CAUTION READ CAREFULLY BEFORE YOU CHECK A BLOCK****
Federal law requires that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and/or imprisonment.
I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked.
(no tenths) 1. The mileage stated is in excess of its mechanical limits.
Odometer Reading 2. The odometer reading is not the actual mileage. WARNING - ODOMETER DISCREPANCY
TOTAL CONSIDERATION AND TRADE-INFORMATION
Giving a false statement as to the total consideration paid is a Class D Felony with a minimum fine of $2000.
Sale Price $ Trade In $ Net Cost $ Tax $
(Credit allowed only on vehicles registered in KY and applicant has paid tax.)
Make Year VIN No. Title No. { Make Year VIN No. Title No. Trade In
Date of Sale
Seller and buyer further certify subject to penalties of forgery in the second degree, that each has supplied true and correct information to the best of his knowledge and belief, in this document, including the above affidavit
JOINT OWNERSHIP: OR AND NOTE: If neither box is checked the Title Transfer will require both signatures
NAME OF SELLER DEALER NO. NAME OF OWNER/BUYER S.S.# BIRTH MO.
STREET ADDRESS PHONE. NO. NAME OF OWNER/BUYER S.S.# BIRTH MO.
CITY COUNTY STATE ZIP ADDRESS
CITY COUNTY STATE ZIP
I ( have) ( have not) applied for a loan in connection with the vehicle described herein and if not, I ( will) ( will not) apply for a loan within 30 days of this application.
LESSEE NAME OR OTHER FIRST LIENHOLDER
LESSEE ADDRESS ADDRESS
CITY COUNTY STATE ZIP COUNTY LIEN TO BE FILED IN
SELLER’S SIGNATURE OWNER/BUYER (S) SIGNATURE (S)
SELLER’S SIGNATURE OWNER/BUYER (S) SIGNATURE (S)
Date of Transfer
Attesting Official Title Attesting Official Title
Subscribed and sworn to before me this day of 20 Subscribed and sworn to before me this day of 20
My commission expires My commission expires
COUNTY CLERK USE ONLY
TYPE APPLICATION DATE OF ISSUANCE TITLE NO. PLATE NO.
I certify under above described penalty that I have reviewed this application and the documents supporting it and that the same are present and consistent with this application; that I received the
application on the date and time indicated hereon and that fees were collected as indicated. I further certify that the required information has been entered into the automated vehicle identification
system (AVIS)
SIGNATURE & TITLE OF ISSUER COUNTY DATE
I certify that the lien indicated to be filed has been noted into the automated system and that a title will be withheld for 30 days, or until financing statement and fees required are received,
whichever occurs first.
SIGNATURE DATE
DO NOT ACCEPT TITLE SHOWING ANY ERASURES, AL