Transcription of VEHICLE DESCRIPTION - West Virginia
1 DMV-1-IRPREVISED 07/2017 FOR DMV USE ONLYCLASSNUMBEREXP. DATEWest Vir ginia Department of TransportationDivision of Motor VehiclesIRPIRPIRPTYPE OR PRINT IN BLUE OR BLACK INKTHIS title APPLICATION MUST BE SIGNED BY THE purchaser (S)/OWNER(S)MAKE CHECKS PAYABLE TO THE DIVISION OF MOTOR ARE ON THE REVERSE SIDE OF THIS : purchaser (s)/Owner(s) Name(s)Mailing AddressMakeName of LienholderThis is to certify that the above described motor VEHICLE was acquired from onmotor VEHICLE as upon the date of sale, and transfer of ownership. Additionally the mileage stated is (check if applicable): and sold to the above named purchaser on Mailing AddressLien AmountLien DateDealer NameDealer License AddressDealer SignatureName of Insurance CompanyName of Insurance AgentInsurance Policy NumberNational Association of Insurance Commissioners (NAIC) NumberCost/Purchase Pric eTrade-I nNet Cost6% Sales TaxStyle of BodyTrucks RequestedWeight ( GVW) title BrandKind of LienYearVINMakeTitle CITY/TOWN COUNTY STATE ZIP CODE CITY/TOWN STATE ZIP CODE CITY/TOWN STATE ZIP CODEMONTH, DAY, AND YEARMONTH, DAY, AND YEARPRINTED COMPANY NAMEPURCHASER(S)/OWNER(S) SIGNATURE(S) - POWER OF ATTORNEY DOCUMENTS MUST BE PROVIDED IF NOT SIGNED BY THE OWNER(S)
2 DESCRIPTIONTRADE-IN DESCRIPTIONMOTOR VEHICLE LIABILITY INSURANCE INFORMATION - A POLICY MUST BE IN EFFEC T WHEN THIS APPLICATION IS AND ENCUMBRANCESDEALER CERTIFICATIONS alvageC/S/CTOO therD/TS/AReconstructedand certify that all statements made herein are true and correct to the best of my knowledge and belief under penalty of law; 17A-9-1: Fraudulent Applications. and certify that all statements made herein are true and correct to the best of my knowledge and belief under penalty of law; 17A-9-1: Fraudulent Applications. (X)(X)IRPIRP1.) IN EXCESS OF IT S MECHANICAL LIMITS2.) IS NOT THE ACTUAL MILEAGEWARNING: ODOMETER DISCREPANCY3.) NOT APPLICABLEGVW OVER 16,000 POUNDSIRPI nstructionsChecklist Complete this application in BLUE OR BLACK INK ONLY. DO NOT SEND CASH. SEND CHECK OR MONEY ORDER payable to the Division of Motor Vehicles. Any check that is not honored for payment will result in a $ SERVICE CHARGE. are TO title AND APPORTION A MOTOR VEHICLE THAT IS NEW AND NEVER BEEN TITLED1) DMV-1-IRP Completed by the dealer2) P roperly assigned by the dealer3) Fees: $ for title , $ per lien.
3 Apportioned registration fees will be billed ) IRP - Schedule C Application 5) from the company must be included PROCEDURES TO title AND APPORTION A MOTOR VEHICLE THAT IS USED AND LAST TITLED IN ANOTHER STATE1) DMV-1-IRP Completed by the purchaser2) Out-of-state title Properly reassigned by the seller3) Fees: $ for title , $ per lien. Apportioned registration fees will be billed ) IRP - Schedule C Application 5) from the company must be included PROCEDURES TO title AND APPORTION A MOTOR VEHICLE THAT IS USED AND WAS LAST TITLED IN WEST VIRGINIA1) Properly reassigned by the seller and with the Application for title section properly completed by the purchaser (Section 7)2) Fees: $ for title , $ per lien. Apportioned registration fees will be billed ) IRP - Schedule C Application 4) Is the application completed, including signatures?Is a power of att orney included where required?Did you enclose a check or money order payable to DMV for the total fees and payment due?
4 Do you have all required documents as outlined above?MAIL ALL REQUIRED DOCUMENTS, FORMS, AND PAYMENT TO:Division of Motor Vehicles | Motor Carrier Services5707 MacCorkle Avenue, SE, PO Box 17900 Charleston, WV 25317 Telephone (304) 926-0799 Fax (304) 926-0797 IRP
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