Corrected or Substitute Title Application - NCDOT
MVR-5
(Rev. 08/18)
YEAR
North Carolina Division of Motor Vehicles
Corrected or Substitute Title Application
MAKE
VEHICLE SECTION
BODY STYLE
SERIES MODEL
TITLE NUMBER
VEHICLE IDENTIFICATION NUMBER
TYPE OF FUEL
ODOMETER READING
ODOMETER BRAND
OWNER SECTION
Owner 1 ID # Owner 2 ID #
Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name
Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company Name
Joint applicants request this title to be issued with Joint Tenants with Rights of Survivorship? Check appropriate block: Yes
No
Residence Address (Individual) Business Address (Firm)
City and State
Zip Code
Mailing Address (if different from above) I certify for the motor vehicle described above that I have financial responsibility as required by law.
Tax County Plate Number
Insurance company authorized in N.C.
Date of Lien Maturity Date Lienholder ID#
FIRST LIEN
Account #
Lienholder Name
LIEN SECTION
Date of Lien Maturity Date Lienholder ID#
Policy Number
SECOND LIEN
Account #
Lienholder Name
Address
Address
City
State
Zip Code
City
State
Zip Code
DISCLOSURE 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.
CHECK REASON FOR CORRECTION OF TITLE
ODOMETER READING
Spelling of name incorrect
Year model in error
Change of name (See notes A & B)
Wrong lienholder (see note D)
Identification number (See note C)
Change of motor or body (See note E)
Body style
Title incorrectly assigned (See note F)
Joint applicants request this title to be issued with Joint Tenants with Rights of Survivorship
Give detailed explanation of alterations and changes:
I, the undersigned, owner of the vehicle described above, hereby certify that the information contained herein is true and accurate to the best of my knowledge.
Signature of owner(s)
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 the
purpose stated therein and in the capacity indicated:
(name(s) of principal(s)).
Notary Signature
Notary Printed or Typed Name
(seal)
My Commission Expires
(See reverse side for lienor's confirmation, regulations and notes)
................
................
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