Transcription of Revised 8-2013 Oklahoma Tax Commission/Motor Vehicle ...
1 Oklahoma Tax Commission / Motor Vehicle DivisionAffidavit for Transfer of Ownership following Loss of Assigned Oklahoma TitleThis application may be utilized only when a properly assigned Oklahoma Certificate of Title was delivered to the applicant by the previous owner and the applicant has lost that Note: This application must be accompanied by confirming ownership transfer documentation ( notarized bill of sale; cancelled check), as well as completed odometer disclosure statements (if a motor Vehicle less than 10 years old), for each ownership assignment outlined , the undersigned, state I was in possession of, and have lost, the described Oklahoma Certificate of Title, and that title certificate was properly assigned to me and others (if applicable) as described and in the sequence outlined InformationThis Vehicle is Currently Subject to the following Lien (if none, indicate None below):Lienholder Name and Address: _____Date/Time of Lien Filing: _____Oklahoma Certificate of Title Number.
2 _____Issued To (record owner): _____Vehicle Identification/Serial Number of Vehicle : _____Make: _____ Model: _____Model Year: _____License Plate and Registration Decal: _____ Purchase Price: _____1st Ownership AssignmentAssigned To: _____ Date of Assignment: _____Address: _____City: _____State: _____Zip: _____Dealer License Number (if applicable): _____2nd Ownership AssignmentAssigned To: _____ Date of Assignment: _____Address: _____City: _____State: _____Zip: _____Dealer License Number (if applicable): _____3rd Ownership AssignmentAssigned To: _____ Date of Assignment: _____Address: _____City: _____State: _____Zip: _____Dealer License Number (if applicable): _____Signature of Owner: _____ Owner s Driver License Number:_____Any false statement in this application subjects the applicant to 777 Revised 8-2013 MVCS ubscribed and sworn to before me this _____day of _____, _____.
3 My commission expires: _____ , _____. _____, Notary PublicNotary SealApplicant Signature / Notary
