FOR DMV USE ONLY Application for Certi˜cate of Title

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 of the West Virginia Motor Vehicle Laws and certify that the statements made are true and correct to the best of my knowledge and belief under penalty of false swearing.

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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