Transcription of FOR DMV USE ONLY Application for Certi˜cate of Title
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NAME(S)MAILINGADDRESSNAMEMAILINGADDRESSN umberStreetCountyCity or TownStateZip YLE OF BODYWEIGHTODOMETER READING(No Tenths) Passenger vehicle onlyTRUCKS Requested (GVW) Title Brands:RECONSTRUCTEDOTHER:PURCHASE PRICE $TRADE IN$NET COST $6% SALES TAX(Credit allowed only on vehicles titled in West Virginia and the tax paid thereon by applicant) 1)2)MakeYearVIN/Serial Virginia Title numberWest Virginia Title number Make of VehicleWeightVIN/Serial NumberT itle NumberLicense Plate Number AMOUNTKIND OF LIENDATES treetCityStateZip CodeC/S/CD/TS/ANAMEMAILINGADDRESSAMOUNTK IND OF LIENDATES treetCityStateZip CodeC/S/CD/TS/A I hereby state that there is a motor vehicle liability policy in e ect on the described vehicle in accordance with the provisions
NAME(S) MAILING ADDRESS NAME MAILING ADDRESS Number Street City or Town County State Zip Code MAKE YEAR V.I.N. STYLE OF BODY WEIGHT ODOMETER READING (No Tenths)
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West virginia department, West Virginia Department of Transportation, Licensee Medical Self-Certification Affidavit, West virginia school bus operator, Virginia Department of Transportation, Department's List of Prequalified Vendors Includes, DEPARTMENT OF, Department of transportation, Transportation, WEST VIRGINIA OFFICE OF MINERS’, WEST VIRGINIA OFFICE OF MINERS’ HEALTH, West Virginia