FOR MVC USE ONLY New Jersey Motor Vehicle Commission Agency Full Transaction ID Application for Certificate of Ownership for a New Vehicle Instructions: 1) This form must be completed for passenger use vehicles that are being titled from an MCO. 2) This form is not required with MCOs for the following vehicles: Motorcycle, RV, ATV, Boat, School Bus, Dump Truck, Tractor, Trailer, Municipal, County, State or Federal Government Vehicles, Construction Vehicles, Commuter Van, Farm Use, Farm Truck, Omnibus/Taxi, or Limousine for commercial hire. Section A: Dealership Information New Vehicle Dealership (Licensed Business Name): Address: Motor Vehicle Dealer Identification Number: Section B: Vehicle Information Vehicle Make: Model: Vehicle Identification Number (17 digits): List the average EPA miles/gallon rating....................................................................................................................................................... (Add both city and highway ratings and divide by 2 OR designate as “Not Rated” and skip to Section E) Section C: Questions 1. Is the average EPA MPG rating (designated in Section B) over 40, AND is the gross sales/lease price of the vehicle equal to or greater than $45,000.00? (Add both city and highway ratings and divide by 2) ............................ YES NO 2. Is the new vehicle certified as a zero emission vehicle by the Commissioner of Environmental Protection? ...................................................................................................................................................................................... 3. Will the new vehicle be registered as a commercial vehicle? ................................................................................................ 4. Will the vehicle be titled and registered outside of New Jersey? ........................................................................................ If you answered YES to any of the above questions, then skip to Section E. Section D: NEW Luxury or Fuel Inefficient Vehicle Surcharge Calculation The surcharge applies to passenger vehicles, light trucks, SUVs, and vans that will not be registered for commercial purposes. YES Is the average EPA MPG rating less than 40 with a gross sales/lease price equal to or greater than $45,000.00? ............................................................................................................................................................................ NO Is the average EPA MPG rating less than 19 with a gross sales/lease price of less than $45,000.00? ........................................................................................................................................................................................................... If you answered YES to either of these questions, then the surcharge is applicable. List the vehicle gross sales/lease price ........................................................................................................................................................ $ Amount of surcharge assessed. Calculate 0.4% of the gross sales/lease price .......................................................... $ Section E: Dealer’s Signature Dealership Authorized Signature: Date: OS/SS-14 (7/06) American LegalNet, Inc. www.FormsWorkFlow.com