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Get SC DMV TI-004A 2006

South Carolina Department of Motor Vehicles TI-004A Est. 4/06 Lost/Stolen or Destroyed Certificate of Title Report When an application is submitted to any Branch Office or Headquarters Unit requesting a Title Correction the registered owner or his agent must complete this form when a title is not present. P. O. Box 1498 Blythewood South Carolina 29016-0024 Vehicle Identification No. Lost/Destroyed Title Number Name of Owner Last First Middle initial Suffix Sr. Jr. III etc. Street Address of Owner City State Telephone Number home I certify that the title listed above was check one Zip Code Lost Date of Loss or Destruction Stolen Destroyed If the title above is recovered I will return it to the nearest DMV Office immediately. Please submit this form along with a corrected Form 400 and applicable fees if due at the address below. P. O. Box 1498 Blythewood South Carolina 29016-0024 Vehicle Identification No* Lost/Destroyed Title Number Name of Owner Last First Middle initial Suffix Sr. Jr. III etc* Street Address of Owner City State Telephone Number home I certify that the title listed above was check one Zip Code Lost Date of Loss or Destruction Stolen Destroyed If the title above is recovered I will return it to the nearest DMV Office immediately. I also understand that I cannot and will not use this title to obtain a lien or transfer ownership of vehicle. Signature of the Registered Owner Date Signature of Person Filing Report Complete this section if the person filing the report is different from the registered owner. Name of Person Filing Report Last First Middle initial FOR DMV USE ONLY BRANCH OFFICE SUBMITTING SPECIALIST S SIGNATURE DATE OF REPORT. Please submit this form along with a corrected Form 400 and applicable fees if due at the address below. P. O. Box 1498 Blythewood South Carolina 29016-0024 Vehicle Identification No* Lost/Destroyed Title Number Name of Owner Last First Middle initial Suffix Sr. Jr. III etc* Street Address of Owner City State Telephone Number home I certify that the title listed above was check one Zip Code Lost Date of Loss or Destruction Stolen Destroyed If the title above is recovered I will return it to the nearest DMV Office immediately. I also understand that I cannot and will not use this title to obtain a lien or transfer ownership of vehicle. I also understand that I cannot and will not use this title to obtain a lien or transfer ownership of vehicle. Signature of the Registered Owner Date Signature of Person Filing Report Complete this section if the person filing the report is different from the registered owner. Signature of the Registered Owner Date Signature of Person Filing Report Complete this section if the person filing the report is different from the registered owner. Name of Person Filing Report Last First Middle initial FOR DMV USE ONLY BRANCH OFFICE SUBMITTING SPECIALIST S SIGNATURE DATE OF REPORT. Jr. III etc* Street Address of Owner City State Telephone Number home I certify that the title listed above was check one Zip Code Lost Date of Loss or Destruction Stolen Destroyed If the title above is recovered I will return it to the nearest DMV Office immediately. I also understand that I cannot and will not use this title to obtain a lien or transfer ownership of vehicle. Signature of the Registered Owner Date Signature of Person Filing Report Complete this section if the person filing the report is different from the registered owner. .

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