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WISCONSIN TITLE & LICENSE PLATE APPLICATION

WISCONSIN TITLE & TITLE No. New LICENSE PLATE No. LICENSE PLATE APPLICATION . MV11-1 5/2015 Amount Received Document No. Processor ID No. Received Date Opened Check Cash DO NOT WRITE ABOVE THIS LINE. Complete form using BLUE or BLACK INK. Section A Vehicle Owner Information APPLICATION Type (check one) TITLE Transfer Original TITLE TITLE Only Salvage TITLE Check if also IRP. Owner Legal Name (Last, First, Middle Initial OR Business Name) Birth Date M M D D Y Y Y Y. Owner Social Security Number Required Driver LICENSE Number Required FEIN Number (if company owned) Required OR OR. 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 2 3 4 5 6 7 8 9.

Vehicle type and use determines the vehicle registration. Fees shown are annual unless otherwise indicated. See instructions for Gross Weight Fee Schedule.

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  Applications, Title, Plate, License, Wisconsin, Wisconsin title amp license plate application

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Transcription of WISCONSIN TITLE & LICENSE PLATE APPLICATION

1 WISCONSIN TITLE & TITLE No. New LICENSE PLATE No. LICENSE PLATE APPLICATION . MV11-1 5/2015 Amount Received Document No. Processor ID No. Received Date Opened Check Cash DO NOT WRITE ABOVE THIS LINE. Complete form using BLUE or BLACK INK. Section A Vehicle Owner Information APPLICATION Type (check one) TITLE Transfer Original TITLE TITLE Only Salvage TITLE Check if also IRP. Owner Legal Name (Last, First, Middle Initial OR Business Name) Birth Date M M D D Y Y Y Y. Owner Social Security Number Required Driver LICENSE Number Required FEIN Number (if company owned) Required OR OR. 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1 2 3 4 5 6 7 8 9.

2 Co-Owner Name (if any) (Last, First, Middle Initial) Birth Date Co-Owner Social Security # or Driver LICENSE # or FEIN Number Required (check one) OR AND . M M D D Y Y Y Y 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17. Street Address (include PO Box if applicable) City State ZIP Code Owner Day time (Area Code) Telephone Number If this is a leased vehicle, list Lessee Name Lessee Social Security # or Driver LICENSE # or FEIN Number Required 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17. Lessee Street Address City State ZIP Code Lessee Day time (Area Code) Telephone Number Section B Vehicle Information Vehicle Identification Number (standard VIN has 17 characters) WI LICENSE PLATE to Transfer Temporary LICENSE PLATE Number PLATE Type 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8.

3 Year Make Type (Car, Truck, Van, etc.) Color Fleet No. (Optional) Date First Operated Vehicle in Wis. as Resident Registration Period Gross Weight Check box if plates transferred between spouses/domestic Vehicle is kept in County City Village Town . partners. LICENSE plates cannot be transferred between other family members. OF: (check one) OF: Section C Loan Information Secured Party Number ALL Secured Party Name(s) (Lienholders). If NO secured party, check 1 2 3 4 5 6 7 8. None Street Address City State ZIP Code (Area Code) Telephone Number Section D Odometer Mileage Selling Dealer Completes Federal and State law requires that seller state the mileage in connection with the transfer of ownership.

4 Failure to complete a mileage statement or providing a false mileage statement may result in fines and/or imprisonment and may make you liable for damages to your transferee (Purchaser). ODOMETER NOW READS: Exempt from odometer disclosure because vehicle is: T . he odometer reading reflects the amount (No Tenths) and to the best of my knowledge is the actual mileage of this vehicle unless one of the statements (to the right) is checked. (No Tenths).. of mileage in excess of its mechanical limit.. The odometer reading is NOT actual mileage. WARNING ODOMETER DISCREPANCY. 10 or more model years old Gross vehicle weight rating exceeds 16,000 lbs.

5 Section E Vehicle Transaction Licensed Dealer's Statement of Sale and Warranty a. Cash price (vehicle described in Section B) $ For value received I hereby sell, assign or trade the vehicle described on this document to the purchaser(s). named in Section A and I certify that all liens shown on the Certificate of TITLE are paid. WARNING: It is a crime to understate the purchase price Dealer Name (Area Code) Telephone Number b. Less trade-in allowance $. Note: WI Dealers need not complete item c below c. Amount subject to tax (a. minus b.) $ Required TITLE Brand (see instructions back of page 3) Dealer Number State Sales Tax (5% of line c.)

6 Police Taxi Flood Damage MFR Buyback Hail Damaged Local Sales Tax if applicable (see Local Sales Tax chart) WISCONSIN Dealer signature also serves as evidence of APPLICATION for TITLE /registration and payment of fees. Fee Computation TITLE Fee $ (Replacement $20) $ (Print Name of Selling Dealer's Authorized Agent). Loan Filing Fee $10 $. X. LICENSE PLATE Fee (see Section H) $ (Selling Dealer's Authorized Agent Signature) (Date). Miscellaneous Fees (see instructions to determine if any apply) CERTIFICATION All parties certify with their signature that to the best of their knowledge the information Wheel Tax (see instructions) $ and statements on this APPLICATION are true and correct.

7 The prior owner's odometer statement has been shown to the applicant and a copy of this completed APPLICATION including odometer statement has been Motor Carrier Class Fee (see Section H) $ furnished the applicant. Other Fees COMMERCIAL CARRIERS I further certify knowledge of applicable federal and state motor carrier Counter Service Fee $5 (If you apply in person at WisDOT) $ safety rules, regulations, standards and orders, and declare that all operations will be conducted in compliance with such requirements. X. Processing Fee (see instructions) $. ENTER FEE TOTAL $. (Owner Signature shown in Section A) (Date).

8 Tax Statement Date Vehicle Purchased Date Delivered (mm/dd/yyyy) X. (Co-Owner Signature) (Date). New Used Describe Year Make Vehicle Identification Number Vehicle Trade-In WI Dealers: Remit state, county & local tax with form ST-12 to WI Dept. of Revenue If tax exempt, enter exemption code and reason (see instructions back of page 3) Make Check Payable To: REGISTRATION FEE TRUST and mail entire APPLICATION & check to: REGULAR SERVICE SPECIAL PLATES. WISCONSIN Dept. of Transportation WISCONSIN Dept. of Transportation 1 DMV 2 SELLER 3 PURCHASER PO Box 7949, Madison WI 53707-7949 PO Box 7911, Madison WI 53707-7911.

9 MV11-2 5/2015. Section F Consent to Purchase I certify that I have legal custody of the person named as owner Date Signed Signature (legal custodian, parent or guardian). UNDER 18 and consent to the purchase by such person and registration of YEARS OLD the vehicle described in the applicant's name. X. County Date my commission expires Date subscribed and sworn to before me Notary Signature NOTARY. PUBLIC X. Section G Non-Operation The vehicle described on this APPLICATION has not been operated upon public highways between dates indicated. From: Through: Section H LICENSE PLATE Types Vehicle type and use determines the vehicle registration.

10 Fees shown are annual unless otherwise indicated.. VEHICLE will be used For Hire . See instructions for Gross Weight Fee Schedule. Authority Number: Automobile AUT Passenger Vehicle/Auto fee = $75. Check Motorcycle CYC Motorcycle of less than 1500 lbs. two-year registration only. Plates expire in April of even numbered years. Fee = $ . MOTORCYCLE/MOPED. manufactured for highway use and displays required Federal MPD Moped (a maximum speed of 30 mph, 50 cc or less if automatic transmission, 130 cc or less if Certification Label. operative pedals) Two-year registration only - plates expire in April of even numbered years.


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