A. VEHICLE B. C. D. E. - Pennsylvania

1 1300-FM-DCNR0043 Rev. 03/2017 PA DEPT OF CONSERVATION AND NATURAL RESOURCES SNOWMOBILE/ATV REGISTRATION UNIT BOX 8553 HARRISBURG, PA 17105-8553 1-866-545-2476 APPLICATION FORM: CERTIFICATE OF TITLE ALL-TERRAIN VEHICLE (ATV) SNOWMOBILE DUPLICATE SECURITY INTEREST REGISTRATION ALL-TERRAIN VEHICLE (ATV) SNOWMOBILE RENEWAL ATV PLATE/SNOWMOBILE DECAL NUMBER OFFICIAL USE ONLY TYPE OR PRINT ALL INFORMATION - ATTACH PROOF OF OWNERSHIP TAX, REGISTRATION AND TITLE FEES A. MAKE OF VEHICLE SERIAL NUMBER (VIN) YEAR MFG 1. PURCHASE PRICE VEHICLE MODEL NAME AND NUMBER DATE OF PURCHASE 2. LESS TRADE IN (COMPLETE BLOCK A) TRADE IN INFORMATION INCLUDING VIN 3. TAXABLE AMOUNT B. LAST NAME (OR FULL BUSINESS NAME) OWNER FIRST NAME MIDDLE INITIAL 4. x 6% (.06) SALES TAX x 7% .07 ALLEGHENY x 8% .08 PHILA (SEE REVERSE) PURCHASER CO-OWNER 5. LESS TAX CREDIT BOX NO. COUNTY 6. SALES TAX DUE STREET 7. APPLICANT'S SALES TAX LICENSE NUMBER CITY STATE ZIP CODE 8.

2 EXEMPTION CODE (SEE REVERSE) C. IF NO SECURITY INTEREST, CHECK 9. SECURITY INTEREST FEE SECURITY FIRST SECURED PARTY SECOND SECURED PARTY 10. REGISTRATION FEE 11. TITLE FEE OR DUPLICATE TITLE FEE 12. GRAND TOTAL D. TEMPORARY REGISTRATION NUMBER DATE ISSUED DEALER NUMBER TEMPORARY REGISTRATION IS GOOD FOR 45 DAYS FROM DATE ISSUED E. ATV CLASS I - Max. width 50", max. dry wt. 1,200 lbs. CLASS II - Width over 50", dry wt. over 1,200 lbs SNOWMOBILE IS THERE A DCNR REGISTRATION PLATE DISPLAYED ON YOUR ATV? YES REG. NO. NO IS THERE A DCNR REGISTRATION DECAL DISPLAYED ON YOUR SNOWMOBILE? YES REG. NO. NO F. REGISTRATION (regular) - Snowmobile/ATV is used off land owned or leased by owner or operator of snowmobile/ATV. LIMITED REGISTRATION - Snowmobile/ATV is used only on land owned or leased by owner or operator of snowmobile/ATV. G. I (WE) CERTIFY THAT I (WE) HAVE EXAMINED THIS FORM AFTER ITS COMPLETION; AND THAT, IF AN EXEMPTION FROM THE PAYMENT OF TAX IS CLAIMED, I AM (WE ARE) AUTHORIZED TO CLAIM THIS EXEMPTION.

3 I (WE) FURTHER CERTIFY THAT ALL STATEMENTS HEREIN ARE TRUE AND CORRECT UNDER PENALTY OF LAW. OWNER X TELEPHONE NUMBER ( ) OWNER X TELEPHONE NUMBER ( ) SEE REVERSE SIDE EXEMPTION CODES EXEMPTION REASON 1. VEHICLE acquired by a Snowmobile or ATV Dealership for the purpose of resale. Insert Sales Tax license number in block number 7 on reverse side. 2. VEHICLE acquired by applicant for rental or lease. (Insert applicant's Sales Tax license number in block number 7 on reverse side.) 3. VEHICLE transferred between husband and wife. (Exemption is not permitted unless transferor holds Pennsylvania title and/or registration.) 4. VEHICLE transferred by an executor, administrator or trustee under a will or trust agreement. 5. VEHICLE brought into Pennsylvania by a nonresident in connection with the establishment of a permanent business or residence. (Requires proof of out-of-state residence.)

4 6. VEHICLE transferred to applicant without consideration or value. Consideration includes the amount of any existing encumbrance or other obligation assumed in connection with the transfer. 7. VEHICLE will be used exclusively by the applicant in his/her farming operation/business. (Exemption not permitted if applicant obtains registration for VEHICLE .) 8. VEHICLE purchased out of state by a nonresident applicant for use in Pennsylvania (Exemption is not permitted if applicant is a resident or if VEHICLE was originally purchased in Pennsylvania .) 9. All vehicles being sold in Allegheny County must be charged the 7% Sales Tax. All vehicles being sold in Philadelphia County must be charged the 8% Sales Tax. TAX CREDIT If applicable tax was paid at time of purchase from dealer, insert amount in block number 5 and attach copy of sales invoice and cancelled check.

5 (If VEHICLE paid with cash, submit copy of receipt.) Send completed application and check to: DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES SNOWMOBILE/ATV REGISTRATION SECTION POST OFFICE BOX 8553 HARRISBURG, PA 17105-8553