| Candidate Information | | Name | Available: Register for Free | | Title | I have worked on restaurants 28 yrs I had my own cleaning servic | | Target Location | US-KY-Cynthiana |
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Division of Motor Vehicle LicensingAPPLICATION FOR KENTUCKY CERTIFICATE OF TITLE OR REGISTRATION TC Street Address 182Street Address /2024Check the type of application desired Duplicate Title Only Transfer First Time Salvage Classic If Duplicate is checked, the original Certificate of Title is: Lost Destroyed Damaged Illegible Other Vehicle Identification SectionVIN MakeYear Body Style Model Model No. ColorMotor No. Cylinders Truck Weight(if motorcycle)CERTIFIED INSPECTOR SECTIONI, (Certified Inspector Print Name)of County, Phone No.do certify under the penalty provisions of KRS 186A.115(4)(d) that I have physically inspected the vehicle described herein to be roadworthy and that the supporting documents are consistent with the vehicle description.THE VEHICLE HAS AN ODOMETER READING OF NO TENTHSTHE VEHICLE IDENTIFICATION NUMBER IS:INSPECTION REQUESTEDBYOWNER DRIVER LICENSE NO. & STATECERTIFIED INSPECTORS SIGNATURE INSPECTOR NO. DATE TITLE BRAND DISCLOSURECheck appropriate block if: Rebuilt Vehicle Water Damage If block is checked and title does not include brand, provide jurisdiction and title number if previous brand was issued.ODOMETER DISCLOSURE CAUTION READ CAREFULLY BEFORE YOU CHECK A BLOCK 49 USC Sec. 32705 and KRS 190.300 require that you state the mileage upon transfer of ownership. Failure to complete or providing a false statement may result in fines and or imprisonment. I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked.(no tenths) 1. The mileage stated is in excess of its mechanical limits. Odometer Reading 2. The odometer reading is not the actual mileage. WARNING ODOMETER DISCREPANCY. TOTAL CONSIDERATION AND TRADE-IN INFORMATIONSale Price $ Trade In $ Net Cost $ Tax $Date of SaleSeller and buyer certify pursuant to the penalty provisions of KRS 190.990(5),that each has supplied true and correct total consideration information to the best of their knowledge and belief in this document, including the above affidavit. JOINT OWNERSHIP: OR AND NOTE: If neither box is checked the Title Transfer shall require both signatures. NAME OF SELLER DEALER NO. NAME OF OWNER/BUYER KY DL#, KY ID#, S.S.#, or FEIN BIRTH DATE STREET ADDRESS PHONE NO. NAME OF OWNER/BUYER KY DL#, KY ID#, S.S.#, or FEIN BIRTH DATE CITY COUNTY STATE ZIP STREET ADDRESS PHONE NO.EMAIL ADDRESS CITY COUNTY STATE ZIPEMAIL ADDRESSI ( have) ( have not) applied for a loan in connection with the vehicle described herein and if not, I ( will) ( will not) apply for a loan within 30 days of this application. LESSEE NAME OR OTHER KY DL#, KY ID#, S.S.#, or FEIN BIRTH DATE FIRST LIENHOLDER LESSEE ADDRESS ADDRESSCITY COUNTY STATE ZIP COUNTY LIEN TO BE FILED INSELLERS SIGNATURE OWNER/BUYER(S) SIGNATURE(S)SELLERS SIGNATURE DATE OF TRANSFER OWNER/BUYER(S) SIGNATURE(S) Attesting Official Title Attesting Official TitleSworn or affirmed before me this day of 20 Sworn or affirmed before me this day of 20 My commission #: Expiration: My commission #: Expiration: COUNTY CLERK USE ONLYTYPE APPLICATIONDATE OF ISSUANCETITLE NO.PLATE NO.I certify subject to the penalty provisions of KRS 190.990(5) that I have reviewed this application and the documents supporting it and that the same are present and consistent with this application; that I received the application on the date and time indicated hereon and that fees were collected as indicated. I further certify that the required information has been entered into the automated vehicle identification system. SIGNATURE & TITLE OF ISSUER COUNTY DATEI certify that the lien indicated to be filed has been noted into the automated system and that a title will be withheld for 30 days, or until financing statement and fees required are received, whichever occurs first. Signature Date DO NOT ACCEPT TITLE OR APPLICATION SHOWING ANY ERASURES, ALTERATION, OR MUTILATIONS. MUST BE COMPLETED IN BLUE OR BLACK INK IF NOT COMPLETED ON-LINE. Make Model Year VIN No. Title No.Make Model Year VIN No. Title No. |
