Purchase Price $ ______________________ Sales/Use Tax $ ______________________ Ex. Code__________ Initials_____________ NJ Motor Vehicle Commission Special Services Titles P.O. Box 017 Trenton, NJ 08666-0017 APPLICATION FOR CERTIFICATE OF OWNERSHIP PLEASE DESCRIBE THE VEHICLE ACCURATELY MAKE OF VEHICLE (PRINT) MODEL YEAR COLOR BODY TYPE NO. OF AXLES I COMPLETE VEHICLE IDENTIFICATION NUMBER (NOT THE MOTOR NUMBER) ODOMETER READING TENTHS PLEASE C H E C K "YES" OR " N O " Does your vehicle now have a lien? (Is your vehicle financed?) Yes No If you checked "yes" PRINT name and address of bank or finance company below. If you checked "No", print 'NONE" in the box below. LIENHOLDER OWNER NAME OF BANK OR FINANCE COMPANY (LIENHOLDER), IF NO LIEN PRINT "NONE" LIENHOLDER CORPCODE STREET ADDRESS OF LIENHOLDER NAME AND ADDRESS OF OWNER AND CO-OWNER BELOW NAME N.J. DRIVER LICENSE NO. (IF BUSINESS-CORPCODE) DATE OF BIRTH STREET CITY, STATE, ZIP CODE NAME EYE COLOR SEX CO-OWNER N.J. DRIVER LICENSE NO. (IF BUSINESS-CORPCODE) DATE OF BIRTH STREET CITY, STATE, ZIP CODE EYE COLOR SEX STATEMENTOF APPLICANT(S): The undersigned hereby certifies all of the above to be true and correct and that the identification number shown on this form has been compared to the identification number on the motor vehicle and further certifies that they agree in every particular. SIGN HERE SIGN HERE x OWNER x CO-OWNER (if any) DATE SIGN HERE DATE SIGN HERE x CO-OWNER (if any) x CO-OWNER (if any) DATE DATE OS/SS-7 (R2/09) American LegalNet, Inc. www.FormsWorkFlow.com