Title Replacement Request Form

TITLE REPLACEMENT REQUEST FORM

Use this form to request issuance of a replacement certificate of title for a vehicle when the original title has been lost, destroyed, stolen, incorrect, or requires reissuance due to name or ownership correction. Complete all applicable sections and sign the certification at the end. False statements made in this request may subject the signer to civil and criminal penalties under applicable law.

Applicant Information

Applicant Name:

Vehicle Information

Lienholder Information

No lienholder on record

Reason for Replacement

Select applicable reason(s):

Lost Stolen Damaged / Illegible

Name change / Correction Error on title Other

Mailing and Delivery Preference

Where should the replacement title be mailed?

Mail to applicant at mailing address above Mail to lienholder listed above

Payment and Fees

Replacement title fees are payable at the time of submission. Fees are non-refundable. Enter the amount included with this request and method of payment.

Required Documents Checklist

Check all documents included with this request. Failure to provide required documentation may delay processing.

Proof of identity (government-issued photo ID)

Proof of ownership (bill of sale, registration)

Lien release (if applicable)

Police report (if title was stolen)

Name change documentation (if applicable)

Power of attorney (if signing on behalf of owner)

Certification and Authorization

I, the undersigned applicant, certify under penalty of perjury that I am the lawful owner of the vehicle described above or I am duly authorized to act on behalf of the lawful owner. The facts stated in this application are true and correct to the best of my knowledge. I understand that issuance of a replacement title may be conditioned upon clearance of any recorded liens and that I remain liable for all obligations secured by such liens. If the original title is subsequently located, I agree to return it immediately to the issuing agency.

I authorize the appropriate motor vehicle authority to issue a replacement certificate of title and to disclose necessary information to lienholders or other parties as required to process this request. I acknowledge that making a materially false statement on this form may constitute fraud and may result in civil or criminal penalties.

Acknowledgment

By signing below, I affirm that I have read the foregoing statements and that they are true and correct. I understand the processing fees are non-refundable and that additional documentation may be requested to verify identity, ownership, or lien status.

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