Transcription of VR-005 04-21
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VR-005 04-21
APPLICATION FOR CERTIFICATE OF TITLEVR-005 ( 04-21 )READ INSTRUCTIONS ON REVERSE SIDEAPPLICANT S FIRST NAME MIDDLE LAST CO-APPLICANT S FIRST NAME MIDDLE LASTAPPLICANT S SOUNDEX/MARYLAND DRIVER S LICENSE NO. DATE OF BIRTH CO-APPLICANT S SOUNDEX/MARYLAND DRIVER S LICENSE NO. DATE OF BIRTHMONTH DAY YEAR MONTH DAY YEARAPPLICANT S STREET ADDRESS CITY OR TOWN CO-APPLICANT S STREET ADDRESS CITY OR TOWNCOUNTY STATE ZIP CODE EMAIL ADDRESS COUNTY STATE ZIP CODE EMAIL ADDRESSIS THE VEHICLE TO BE TITLED AS JOINT TENANTS OR TENANTS BY ENTIRETIES? JOINT TENANTS TENANTS BY ENTIRETIES NEW VEHICLE USED VEHICLEMODEL YEARMAKE OF VEHICLEMODEL IDENTIFICATION NUMBERMODEL YEARMAKE OF VEHICLETYPE OF FUEL# OF CYLINDERSMOTOR CARRIER #UNIT # TWO STAGE VEHICLECOMPLETE MAKE & YEAR FOR EACH VEHICLE TRUCK TRUCK AXLES BUSSEATS MOTORCYCLEENGINE NO.
imprisonment. I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked: ODOMETER READING _____ (NO TENTHS) £ 1. The mileage stated is in excess of its mechanical limits. £ 2. The odometer reading is not the actual mileage.
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