Fill and Sign the Mn Issuance Form

State of Minnesota District Court County Judicial District: Court File Number: Case Type: Plaintiff Notice of Motion, Motion and vs. Affidavit for Order Directing Issuance of Title to a Motor Vehicle (Minn. Stat. §§ 168A.04, 168A.08 168A.25) Defendant (seller of vehicle) Commissioner of Public Safety Defendant NOTICE OF MOTION AND MOTION To: The Above-named Defendant: and The Commissioner of the Department of Public Safety C/O Attorney Generals Office, Public Safety Division 445 Minnesota Street, Suite 1800 St. Paul, MN 55101-2134 TAKE NOTICE that on , at .m. at Date (Time) (Location) before the Honorable , I will move the Court for the following order: That the Department of Public Safety, Division of Motor Vehicle Registration, shall issue a title and registration for the following vehicle: License Plate No.: Vehicle Identification Number: to AFFIDAVIT I , state: (first, middle, last) 1. I am the Plaintiff in this action. My date of birth is: MOV102 State ENG Rev 10/18 www.mncourts.gov/forms Page 1 of 5 2. I purchased the vehicle described below from (Seller’s name and address): for $ on Date Make Model Year License Plate No. Vehicle Identification No. Vehicle Body Type New Used Odometer This is the true cumulative mileage. It is unknown whether this is the true cumulative mileage. To the best of buyer(s) knowledge this vehicle: Has sustained damage in excess of 70% actual cash value; or Has not sustained damage in excess of 70% actual cash value. 3. I am the sole owner of this vehicle. OR The following individual(s) is/are co-owner(s) of the vehicle: Provide first, middle, last name; address; and date of birth of each co-owner: 4. I paid in full the above amount and there is: No other secured interest in the vehicle. OR The secured party, , has issued a Notice of Release. In order of priority, list Name , Address and Dates of security agreements of any secured parties: MOV102 State ENG Rev 10/18 www.mncourts.gov/forms Page 2 of 5 5. I have been unable to obtain a certificate of title from the former owner for the following reason(s): I have been unable to locate the former owner to obtain the Certificate of Title for the vehicle. Other (specify): 6. The reason given by the Department of Public Safety for not issuing a title is: The Department has reasonable grounds to believe that I am not the owner of the vehicle; The Department has reasonable grounds to believe that the application contains a false or fraudulent statement; I have failed to furnish required information or documents or any additional information the Department reasonably requires; I have not paid at least one month’s registration tax or registered the vehicle under Minn. Stat. § 168.187. 7. I was told that I could obtain a title for the vehicle only if I posted a bond in the amount of $______________. I have posted the bond. I have not posted the bond. MOV102 State ENG Rev 10/18 www.mncourts.gov/forms Page 3 of 5 I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature County and State where signed Name: Address: City/State/Zip: Telephone: E-mail address: MOV102 State ENG Rev 10/18 www.mncourts.gov/forms Page 4 of 5