New York State Department of Motor Vehicles Batch File No. IN-TRANSIT PERMIT/TITLE APPLICATION www.nysdmv.com Orig Activity PLEASE PRINT CLEARLY O F F I C E New Plate Scofflaw Case Number(s) Special Conditions: USE ONLY DEALER EX Value ($) Sales Tax Status Information GI Permit Permit Info. Number / What do you want to do? NF Jurisdiction NU OD OV PA RC SA Out of State Audit Rate Date Issued / / New Class Facility ID Number / SO I T P SP SS SV Is there a lienholder? If “Yes”, enter the information below UNLESS the vehicle will be transported out-of-state (in that case, Yes No advise the lender to perfect the lien in that state). Lienholder Name and Mailing Address COMPLETE BOXES INSTRUCTIONS 1 IF Expiration Date Lien Filing Code (Assigned by DMV) ONLY Insurance Company Code 3 of Name Old Class Old Plate 1 2 4 6 7 and . COMPLETE BOXES 3 AND 5 ONLY IF NECESSARY. PLEASE PRINT CLEARLY. Transport this vehicle to register it at some place outside of New York State. Transport this vehicle within New York State to register it in another part of New York State. Transport this vehicle to obtain the required NYS Department of Transportation or NYS Heavy Vehicle inspection (see page 2 for requirements). Change information on a current in-transit permit. This vehicle will be transported FROM (point of origin, including city and state): _________________________________________________________________________ TO (destination, including city and state or country): __________________________________________________________________ NOTE: NOT VALID IN MASSACHUSETTS 2 CLIENT ID NO.(from Driver License of first registrant listed below) NAME CHANGE? (See Box 5 YES Is this registration for a corporation or partnership? Yes No ADDRESS CHANGE? NO on page 2.) YES NO NAME OF REGISTRANT (Last, First, Middle) DATE OF BIRTH Month ADDRESS WHERE YOU GET YOUR MAIL ADDRESS WHERE YOU LIVE 3 Day M (Include Street Number and Name, Rural Delivery and/or box number) Apt. No. City or Town Area Code ( ) F State IF YOU ARE NOT THE OWNER of this vehicle, the owner must complete this section. Proof of ownership and proof of owner’s name and date of birth are required. NOTE -You do not have to fill in this section if you attach a completed Registration Authorization (MV-95), or if you are renewing the vehicle, and the owner is the same. Zip Code County State (IF DIFFERENT FROM MAILING ADDRESS) - DO NOT GIVE P.O. BOX Apt. No. City or Town NAME OF CURRENT OWNER (Last, First, Middle) DAY PHONE NO. (Optional) SEX Year Zip Code County OWNER CLIENT ID NO. (from Driver License) Month Day OWNER’S DAY PHONE NO. (Optional) SEX DATE OF BIRTH Year M F Area Code ( ) ADDRESS WHERE OWNER GETS MAIL (Include Street Number and Name, Rural Delivery and/or box number) Apt. No. AUTHORIZATION: The registrant named in Box 2 City or Town State is authorized to register the vehicle described in Box 4 Zip Code . (Owner’s/Authorized Signature-Co-owner’s Signature if applicable) 4 VEHICLE IDENTIFICATION NUMBER (Date) Body Type For Cars VEHICLE DESCRIPTION Year Make 2-Door Color Van Cylinders OFFICE USE ONLY Motorcycle Tow Truck For trailers & commercial vehicles Max. Gross Weight Mileage Brand Prior Trailer Convertible Station Wagon/ Suburban Other______________ Unladen Weight Gas Other _______ For rentals,buses & taxis Seating Cap. Odometer Reading in Miles Title Owner Proof Submitted (Name and Ownership) Reg/Title No._________________________________________ State_______________ MV-82ITP (3/10) 4-Door Type of Power (Fuel) Body Type For Other Vehicles Pick-up County Lien Diesel Electric Flex CNG How many numbers can fit in the vehicle’s ODOMETER (5, 6 or 7 -do not include tenths)? Lien Number None Other ________ For trailers & commercial vehicles Distance Axles L.R. Approved By Date Propane Stop/Response Old Fee Operator PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com 5 6 CHANGES To change information on a current registration and/or title, be sure to enter the new information on page 1 of this form. NAME CHANGE: Print former name exactly as it appears on the current registration or title. CHANGES: Describe all changes and the reasons for the changes. Proof of NYS DOT or HEAVY VEHICLE INSPECTION IS required before registration if the vehicle carries passengers AND: a. requires commercial operating authority. b. is a bus with a seating capacity of 15 or more persons. c. provides transportation under a contract with a private school or school district. d. provides transportation to children under age 21 to places of: academic or vocational instruction through grade 12; religious services and/or religious instruction; day camps or day care centers; care or training of persons with a physical and/or mental disability. Proof of NYS DOT INSPECTION or HEAVY VEHICLE INSPECTION IS NOT required before registration if a vehicle: e. is owned and operated by a municipality, a public authority, or a school operated by, or certified by, the Office of Mental Retardation and Developmental Disabilities (OMRDD). f. is owned by the registrant for his or her personal use, and is also used to transport children under age 21, without compensation, to the places described in “d” above. g. is a taxi or livery vehicle which transports children under age 21 to the places described in “d” above, without a contract or agreement for on-going services. For more information about proof of inspection requirements, please see Inspection Requirements for Carriers Transporting Passengers (MV-82.1P). Vehicle Inspection Information We ask for this information to make sure you have all required proofs when you register this vehicle in New York State. 1. See the information above to determine if a NYS DOT inspection or a NYS Heavy Vehicle inspection is required. If one of these inspections is required, check this box . . . . . . . . 2. I certify that, to the best of of my knowledge, this vehicle has been or has not been wrecked, destroyed or damaged to such an extent that the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of loss. (Checking the “has been” box means the vehicle must have an anti-theft examination before being registered, and that the title issued will have the statement “Rebuilt Salvage: NY” on it.) 3. Does this vehicle require a commercial operating authority permit? Yes If “Yes”, give NYS DOT Permit No. _________________________ I.C.C. Permit No. ____________________________ 4. Is it used as an ambulette? 7 Yes No No If “Yes”, check this box if payment is received to carry passengers CERTIFICATION: The information I have given on this application is true to the best of my knowledge. I certify that the vehicle is fully equipped as required by the Vehicle and Traffic Law, and has passed the required New York State inspection within the past 12 months, or has qualified for a time extension (Form VS-1077) and will be inspected within 10 days. I also certify that appropriate insurance coverage is in effect, and that the vehicle will be operated in accordance with the Vehicle and Traffic Law. If I am applying for replacement registration items, I certify that the registration is not currently under suspension or revocation. If I am using a credit card for payment of any fees in connection with this application, I understand that my signature below also authorizes use of my credit card. Print Name Here ± (Print Name in Full - if registering for a corporation, print your full name and title) Additional Signature Sign Here ± Sign Here ± (Sign Name in Full) (Sign Name in Full -Additional signature required for a partnership or if registering this vehicle in more than one name.) CREDIT CARD AUTHORIZATION IF CARDHOLDER IS NOT THE APPLICANT: My signature authorizes __________________________________________ to use my credit card for payment of any fees in connection with this application, and I understand that I must be present for this transaction. Sign Here ± (Cardholder-Sign Name in Full) IMPORTANT: Making a false statement in any registration application or in any proof or statements in connection with it, or deceiving or substituting in connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in the revocation or suspension of the registration pursuant to regulations established by the Commissioner. The Department makes no representation that it will issue a certificate of title or transferable registration until the Commissioner is satisfied that the applicant is entitled to a certificate of title or transferable registration, and until all documentation required to establish ownership of the vehicle is submitted and deemed to be satisfactory. Pending review of this application, neither the Commissioner of the Department of Motor Vehicles nor any of his or her employees, deputies or agents assumes any liability or responsibility for repairs performed, improvements made or work done to the vehicle referenced in this application. To Be Completed by a Registered New York State Dealer Only – List any additional Lienholders Lien Filing Code (Assigned by DMV) _____________________________________ Lienholder Name____________________________________________________________________ Mailing Address _____________________________________________________________________________________________________________________________ (Number and Street) Lien Filing Code (Assigned by DMV) ________________________________ (City) (State) (Zip Code) Lienholder Name ________________________________________________________________ Mailing Address______________________________________________________________________________________________________________________________ (Number and Street) (City) DEALER CERTIFICATION: I certify that all information provided on this application is true. I take responsibility for the integrity of the papers delivered to the Motor Vehicles office. MV-82ITP (3/10) (State) (Zip Code) __________________________________________________ (Signature of Dealer or Authorized Representative) PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com