Transcription of Warning odometer discrepancy!
1 Vehicle Section:Except for the signature, this application must be typed, electronically completed & printed or legibly hand printedin black or blue Identification NumberYearMakeBody StyleModelColorCylindersNew or UsedDate PurchasedEmission Certificate #Current Title #Current Title s State of IssueGA County of ResidenceDistrict # odometer Reading Warning odometer discrepancy !Complete For All Commercial VehiclesGross Vehicle Weight & Load Straight Truck? Used For Hire? Type of Trailer Pulled?Product Hauled? Is This A Farm Vehicle? _____ Yes No Yes No _____ Yes NoNumber of Owners_____ Owner Section Leased Vehicle? No YesOwner # 1MV-1 (Revised 11-2013)Full Legal Name of Owner #1 Date of BirthIf you purchased this vehicle from an out-of-state dealer/business, did you pick-upthe vehicle out-of-state?
2 Yes NoOwner # 2 Full Legal Name of Owner #2 Date of BirthAddress (Street address including city, state & zip)Mailing Address (If different from street address including city, state & zip)Seller SectionLessee SectionFull Legal Name or Business Name & Address:Le ssee s Full Legal Name & Address or Business Lessee s Full Name & Address:If Georgia Seller, GA County Name Le ssee s GA County LocationSecurity Interests or Liens SectionName & Address of 1stSecurity Interest Holder/Lien Holder:Name & Address of 2ndSecurity Interest Holder/Lien Holder:Name & Address of 3rdSecurity Interest Holder/Lien Holder:Name & Mailing Address of Attorney-in-Fact - Attach original power of attorney if title is tobe mailed to do solemnly swear or affirm under criminal penalty of a felony for fraudulent use of a false or fictitious name or address or for making a material falsestatement punishable by fine up to $5,000 or by imprisonment of up to five years, or both, that thestatements contained herein are true & #1 Signature_____ Owner #2 Signature_____*A Georgia license plate and registration will not be issued until the applicant presents, at th e time of application, their valid Georgia driver s license orDOR - Motor VehicleTitle/Tag ApplicationGA Dealer s/Bank s 12 Digit Customer ID# (If Applicable)Number of Security Interests or Liens.
3 _____ Driver s License #, if individual*Security Interest Holder's/Lien Holder's ELT 12 Digit Customer ID#Security Interest Holder s/Lien Holder s ELT 12 Digit Customer ID #Security Interest Holder s/Lien Holder s ELT 12 Digit Customer ID #Georgia identification card. Owner's E-mail Address_____ $ * Directly Financed Dealer Sale
