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Get WV DMV-4-TR 2012

DMV-4-TR REV 7/12 West Virginia Department of Transportation Division of Motor Vehicles A davit of Duplicate Title for a Vehicle or Watercraft MAIL TO Receiving and Processing PO Box 17710 Charleston WV 25317 1-800-642-9066 www. Dmv.wv.gov PRINT IN BLUE OR BLACK INK ONLY. THIS APPLICATION MUST BE ACCOMPANIED BY A COPY OF THE OWNER S DRIVER S LICENSE. ENCLOSE A COPY OF YOUR REGISTRATION CARD IF AVAILABLE. IF LOST TITLE SHOWED A LIEN RELEASE SECTION D MUST BE COMPLETED. THERE IS A 10. 00 FEE FOR YOUR DUPLICATE TITLE. Select Reason for Requesting Duplicate Check Only One Vehicle Title Lost Boat Title Destroyed Defaced attach defaced title A. dmv*wv*gov PRINT IN BLUE OR BLACK INK ONLY. THIS APPLICATION MUST BE ACCOMPANIED BY A COPY OF THE OWNER S DRIVER S LICENSE* ENCLOSE A COPY OF YOUR REGISTRATION CARD IF AVAILABLE* IF LOST TITLE SHOWED A LIEN RELEASE SECTION D MUST BE COMPLETED. THERE IS A 10. 00 FEE FOR YOUR DUPLICATE TITLE* Select Reason for Requesting Duplicate Check Only One Vehicle Title Lost Boat Title Destroyed Defaced attach defaced title A. Owner s Information Name Never Received Change of Address B. Vehicle/Watercraft Information Make Year VIN or Hull No OWNER S NAME S Address Plate or Reg* No STATE CITY ZIP Body Style or Hull Material C. Owner/Applicant Certification The undersigned applicant being duly sworn upon oath deposes and says they are the owner of the vehicle/watercraft described herein constitute the crime of perjury. Furthermore I agree to indemnify and hold harmless the West Virginia Division of Motor Vehicles from any liability arising from this transaction* I understand that the penalty for false statement in this application holds a ne of not more than 100. 00 or imprisonment in the county jail for thirty days or both. This application must be signed by the owner s. If a person other than the applicant is signing this application a power of attorney form is required* If the title reads AND both owners signatures MUST appear. If signing for a company indicate your title or position* X SIGNATURE OF APPLICANT OR LEGAL REPRESENTATIVE D. Discharge of Lien Holder s If the vehicle or watercraft has EVER had a lien against it section D MUST be completed by the lien holder before a clear title can be issued* If section D is not completed the title will be mailed directly to the lien holder on record. lien holder has no interest in the above vehicle/watercraft. Name of Lien Holder SIGNATURE OF OFFICER TITLE This lien is fully paid satisfied and released this day of / SIGNATURE OF NOTARY. COMMISSION EXPIRATION DATE E* Release Affidavit I VEHICLE OR WATERCRAFT OWNER hereby authorize SIGNATURE OF OWNER DIVISION USE ONLY Verified in Computer NAME OF DEALERSHIP LIEN HOLDER OR INDIVIDUAL to receive my duplicate title. THERE IS A 10. 00 FEE FOR YOUR DUPLICATE TITLE* Select Reason for Requesting Duplicate Check Only One Vehicle Title Lost Boat Title Destroyed Defaced attach defaced title A. Owner s Information Name Never Received Change of Address B. Vehicle/Watercraft Information Make Year VIN or Hull No OWNER S NAME S Address Plate or Reg* No STATE CITY ZIP Body Style or Hull Material C. .

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