Transcription of Rev. 11/2021 Division of Motor Vehicles - West Virginia
1 1-800-642-9066 InsurancePO Box 17020 Charleston, WV 25317 DMV-1-SRev. 11/2021 West Virginia Department of Transportation Division of Motor VehiclesSold Vehicle or Watercraft notice A) Owner/Seller s Information PRINT USING BLACK INK ONLY B) Purchaser s Information If vehicle was sold to a salvage yard or junk dealer, list the name below as the Phone AddressSTREET ADDRESSCOUNTYCITYSTATEZIPZIP( )NameDaytime Phone AddressSTREET ADDRESSCOUNTYCITYSTATE( ) C) Vehicle/Motorboat Information D) Buyer/Seller SignaturesMakeTitle NumberYearDate of SaleSale Price Serial/VINN umber SIGNATURE OF SELLER(X)DAT E// SIGNATURE OF BUYER(X)DAT E// SIGNATURE OF BUYER(X)DAT E// SIGNATURE OF SELLER(X)
2 DAT E//I certify under penalty of law that the above information is true and accurate to the best of my knowledge.**IF THE TITLE READS AND , BOTH SELLERS MUST SIGN. IF AVAILABLE, HAVE BOTH BUYERS SIGN.**ANY PERSON WHO KNOWINGLY: MAKES A FALSE STATEMENT; CONCEALS A MATERIAL FACT; OR OTHERWISE COMMITS FRAUD, IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A $1000 FINE, ONE YEAR IMPRISONMENT, OR BOTH. **DO NOT USE THIS FORM, if you have junked the vehicle. **If the sale date is unknown, list the approximate price.**This notice will not be accepted if any lines are left blank.* If the buyer s name is unknown, list name as UNKNOWN .$//
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