VEHICLE REGISTRATION/ TITLE APPLICATION This form is available at dmv.ny.gov Office Use Only Batch File No. Orig Dup Activity Activity W/RR Renewal Renew W/RR Class Lease Buyout Sales Tax with Title Three of Name I WANT TO: REGISTER A VEHICLE CHANGE A REGISTRATION RENEW A REGISTRATION REPLACE LOST OR DAMAGED ITEMS GET A TITLE ONLY TRANSFER PLATES Plate Number 1 NAME OF PRIMARY REGISTRANT (Last, First, Middle or Business Name) NYS driver license ID number of PRIMARY REGISTRANT DATE OF BIRTH Month Day Year GENDER Male Female NAME OF CO-REGISTRANT (Last, First, Middle) NYS driver license ID number of CO-REGISTRANT DATE OF BIRTH Month Day Year GENDER Male TELEPHONE NUMBER Area Code Female MOBILE TELEPHONE NUMBER Area Code NAME CHANGE? YES NO ADDRESS CHANGE? YES NO ( ) EMAIL ( ) FORMERNAME (If name was changed you must present proof)) THE ADDRESS WHERE PRIMARY REGISTRANT GETS MAIL (Include Street Number and Name, Rural Delivery or box number. This address will be on the document.) Apt. No. City or Town State Zip Code County of Residence THE ADDRESS WHERE PRIMARY REGISTRANT RESIDES IF DIFFERENT FROM THE MAILING ADDRESS. Apt. No. City or Town (DO NOT GIVE A P.O. BOX.) State Zip Code 2 VEHICLE IDENTIFICATION NUMBER VEHICLE DESCRIPTION Year Make Body Type (mark one) 2-Door Convertible 4-Door Pick-up Van Trailer Type of Power (Fuel) Color Unladen Weight Gas Cylinders For trailers & commercial vehicles Maximum Gross Weight Diesel Electric Flex CNG Propane None Office Use Only Mileage Brand Suburban/SUV Tow Motorcycle Other _________ For rentals,buses & taxis Seating Capacity Odometer Reading in Miles For commercial vehicles Axles Distance A CHANGES: Describe any vehicle changes and the reasons for the changes. (SUBMITNYS TITLEIFISSUED) E N 3 If the OWNERof the vehicle is DIFFERENT from the REGISTRANT, the OWNERmust complete this section. NYS driver license number of OWNER NAME OF CURRENT OWNER(s) (Last, First, Middle) DATE OF BIRTH Month Day Year NAME OF CO-OWNER THE ADDRESS WHERE OWNERGETSMAIL ¡ GENDER (Include the Street Number and Name, Rural Delivery or box number) Male County Female Apt. No. City or Town State Zip Code ± (Signature of owner or authorized person, and signature of co-owner if applicable) (Date) Choose one Lien Filing Code ¡ DEALER USE ONLY - LIEN FILING - Alterations are not allowed in the lienholder section below There are no liens I am filing for the lienholder(s) listed below Lienholder Name Lienholder Mailing Address (number, street, city, state, zip code) NEW YORK DEALERS ONLY Did you issue plates to this vehicle? Yes No Plate Number Reg. Class Date Temp Issued Facility IDNumber 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. ±____________________________________________________________ (Signature of Dealer or Authorized Representative) Ins. Co. Code Jurisdiction Special Conditions Audit Lien Release OFFICE USE ONLY New Plate Sales Tax Status Prior Owner Proof Submitted Stop/Response/Scoff Law Reg/Title ______________________________ State_________________ Value ($) Rate New Class Out of State AT IO PA TP BV PI SP TR CF NE PK SR TX CO NF RC SS XR EO NR RE SV X6 EX NU SC TE WO Date FL OP SO TL TO OV Issuance State Title Lien Lien Number Approved By MV-82 (12/16) COMPLETE BOTH SIDES American LegalNet, Inc. www.FormsWorkFlow.com PAGE 1 OF 2 4 ADDITIONAL VEHICLE INFORMATION QUESTIONS 1-3 MUST BE COMPLETED. 1. Has the vehicle 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 to make the vehicle legal to operate on the road or highways, is more than 75% of the retail value of the vehicle at the time of loss? No Yes - (If you marked Yes the vehicle must have an anti-theft examination before it is registered. The title that is issued will have the statement "Rebuilt Salvage" on it.) 2. Is this vehicle registered for your personal use? Yes No If you marked "Yes", go to the next question (question 3) . If you marked "No", check any of these boxes that apply: This vehicle is a passenger vehicle that will be used for hire with a driver and will be operated in the following location(s): New York City (NYC) A jurisdiction that is not NYC that regulates taxis A jurisdiction that does not regulate taxis This vehicle is used as a contracted carrier. This vehicle is a passenger vehicle that is rented without a driver. This vehicle requires a permit for commercial operation. (Mark the box of the type of permit that was issued and write the permit number on the line.) NYSDOTPermit No. ___________________ Federal DOT Permit No. ____________________ The government owns this vehicle. This vehicle is used as (mark one) an ambulance an ambulette If payment is received to carry passengers, mark this box. This vehicle is used exclusively as a hearse a hearse or invalid coach If payment is received to carry passengers, mark this box. This vehicle is a commercial tow truck with a gross vehicle weight rating of at least 8,600 pounds. This vehicle is used only as a farm vehicle. (form MV-260F, Part 1, must be attached) This vehicle is used only as an agricultural truck or agricultural trailer. This vehicle is subject to the Department of Transportation inspection requirements for the carriers that transport passengers. (For more information, refer to form MV-82.1P, "Inspection Requirements for Carriers Transporting Passengers".) 3. Has this vehicle been modified to change its registration class? Yes No If "Yes", explain ______________________________ _________________________________________________________________________________________________________________________ 4. This vehicle is a pick-up truck with an unladen weight that is a maximum of 6,000 pounds. This vehicle is never used for commercial purposes and does not have advertising on any part of it. I want (mark one): Passenger Plates Commercial Plates 5 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 insuranc