APPLICATION FOR CERTIFICATE OF OWNERSHIP
[Pages:1]Purchase Price $ ______________________
NJ Motor Vehicle Commission
Sales/Use Tax $ ______________________
Special Services Titles P.O. Box 017
Ex. Code__________ Initials_____________
Trenton, NJ 08666-0017
APPLICATION FOR CERTIFICATE OF OWNERSHIP
MAKE OF VEHICLE (PRINT)
MODEL
PLEASE DESCRIBE THE VEHICLE ACCURATELY
YEAR
COLOR
BODY TYPE
COMPLETE VEHICLE IDENTIFICATION NUMBER (NOT THE MOTOR NUMBER)
NO. OF AXLES
I
ODOMETER READING
TENTHS
PLEASE CHECK
"YES" OR " N O "
Does your vehicle now have a lien? (Is your vehicle financed?) Yes
No
LIENHOLDER
If you checked "yes" PRINT name and address of bank or finance company below. If you checked "No", print 'NONE" in the box below.
NAME OF BANK OR FINANCE COMPANY (LIENHOLDER), IF NO LIEN PRINT "NONE"
LIENHOLDER CORPCODE
STREET ADDRESS OF LIENHOLDER
CO-OWNER
OWNER
NAME AND ADDRESS OF OWNER AND CO-OWNER BELOW
NAME N.J. DRIVER LICENSE NO. (IF BUSINESS-CORPCODE) DATE OF BIRTH STREET CITY, STATE, ZIP CODE NAME N.J. DRIVER LICENSE NO. (IF BUSINESS-CORPCODE) DATE OF BIRTH STREET CITY, STATE, ZIP CODE
EYE COLOR EYE COLOR
SEX SEX
STATEMENTOF APPLICANT(S): The undersigned hereby certifies all of the above to be true and correct and that the identification number shown on this form has been compared to the identification number on the motor vehicle and further certifies that they agree in every particular.
SIGN HERE x
OWNER
SIGN HERE x
CO-OWNER (if any)
OS/SS-7 (R2/09)
DATE DATE
SIGN HERE
SIGN HERE
x CO-OWNER (if any)
x CO-OWNER (if any)
DATE DATE
................
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