MVR-1

North Carolina Division of Motor Vehicles(Rev. 05/17)

TITLE APPLICATIONCHECK Appropriate Block/s (Application cannot be processed without certification of services)Title Only – Vehicle Not in Operation

 Truck Weight Desired ________________________(This includes the truck, trailer and load)

Title and License PlateClass of License __________________

 Plate No. Transferred ________________________________(List Plate Number and Expiration)

Inoperable Vehicle – Vehicle substantially disassembledand unfit or unsafe to be operated on the highway

 Limited Registration Plate(When property taxes are deferred)

For Hire Vehicle
 Yes or  NoI certify that all the above information is correct. ___________ (Customer’s Initials)

VEHICLE SECTION
YEAR

MAKE

BODY STYLESERIES MODELVEHICLE IDENTIFICATION NUMBER

FUEL TYPEODOMETER READINGOWNER SECTION
Owner 1 ID # ___________________________________________________________________________________________________________________________________________________________________________
Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name

Owner 2 ID # _____________________ ______________________________________________________________________________________________________________________________________________________Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company NameYes

Joint applicants request this title to be issued with Joint Tenants with Rights of Survivorship? Check appropriate block:Residence Address (Individual) Business Address (Firm)

City and StateZip Code

Mail Address (if different from above)

City and StateZip Code

Vehicle Location Address (if different from residence address above)

City and StateZip CodeNo

Tax County

LIEN SECTION
Account #FIRST LIEN
Date of Lien
Lienholder ID #SECOND LIEN
Date of Lien

Maturity Date (MH)Lienholder Name

Lienholder ID #Account #Maturity Date (MH )Lienholder Name

Address ______________________________________________________ __________

Address ____________________________________________________________________

City ______________________ State _________ Zip Code ______________________

City _______________________________ State ________ Zip Code __________________I certify for the motor vehicle described above that I have financial responsibility as required by law.
___________________________________________________________
Insurance Company authorized in N.C.
Purchased New

Purchase Date_________________________________________________________
Policy Number

From Whom Purchased (Name and Address)

N.C. Dealer No.

 UsedIs this vehicle leased?
If Yes, Attach Form MVR-330
 Yes

Equipment # NoDISCLOSURE SECTION
All motor vehicle records maintained by the North Carolina Division of Motor Vehicles will remain closed for marketing and solicitation unless the block below is checked.
 I (We) would like the personal information contained in this application to be available for disclosure.
APPLICATION MUST BE SIGNED IN INK BY EACH OWNER OR AUTHORIZED REPRESENTATIVE OF FIRMS OR CORPORATIONS.
I (we) am (are) the owner(s) of the vehicle described on this application and request that a North Carolina Certificate of Title be issued. I (we) certify that the information on
the application is correct to the best of my (our) knowledge. The vehicle is subject to the liens named and no others. If a registration plate is issued or transferred, I (we)further certify that there has not been a registration plate revocation and that liability insurance is in effect on this vehicle on the date of this application as required by theNorth Carolina Financial Security Act of 1957.
OWNER’S SIGNATURE ______________________________________________________________________________________________________________________Date ________________________________County _______________________________________

State ____________________________________

I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for thepurpose stated therein and in the capacity indicated: _________________________________________________________________________(name(s) of principal(s) ).
NotaryNotary Printed
Signature _____________________________________________________ or Typed Name ______________________________________________________(SEAL)My Commission Expires _______________________________________________