Application For Certificate Of Title & Registration Of A Vehicle - North Dakota
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1
2APPLICATION FOR CERTIFICATE OF TITLE
Motor Vehicle Division
North Dakota Department of Transportation
& REGISTRATION OF A VEHICLE
608 E Boulevard Ave
North Dakota Department of Transportation, Motor Vehicle Division
Bismarck ND 58505-0780
SFN 2872 (Rev. 01-2011)
Phone (701) 328-2725
I. This Application is for:
Web site:
(Check only one)
SEE INSTRUCTIONS ON REVERSE SIDE.
Duplicate plates, tabs & registration card . . . . . . . . . . .
$5.00
Duplicate tabs & registration card . . . . . . . . . . . . . . . . .
$3.00
New or Out-of-State Vehicle
Duplicate registration card only . . . . . . . . . . . . . . . . . .
$2.00
Vehicle License
Duplicate title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$5.00
Gross Weight Increase
Utility Trailer License $5.00
REQUIRED: Reason for Duplicate (Circle: lost, stolen, mutilated)
II. Applicant Information
Applicant's Legal Name (first, middle, last) or Firm Name (Lessor, Trust):
DL
CID
CORPID
FEIN
Telephone Number
(Check One)
Zip
County
Mailing Address
City
State
(Check One)
DL
CID
CORPID
FEIN
Co-Applicant's Legal Name (first, middle, last) or Firm Name (Lessor, Trust):
Telephone Number
Zip
County
Mailing Address
City
State
Check one:
Or
And
And/Joint Tenants with Right of Survivorship
North Dakota Title Number
III. Vehicle Information
Year
Make
Model
Body Style
Fuel Type
Vehicle Identification Number
Color
Weight
Previous Weight
Length (Travel Trailer/Mobile
ND License Plate Number
Credit Plate Number
Home/Motor Home)
Date 1st used on ND Highways
Odometer Reading
Odometer Indicator (check one)
Actual Mileage
Actual Mileage
Exceeds Mechanical Limits
Not Actual
IV. Motor Vehicle Purchaser's Certificate
Full Purchase Price
$
V. Dealer and Lienholder Information
Less Trade-In Allowance
$
Date Acquired
New Vehicle
(Check
Less Total Loss Allowance
Used Vehicle
One)
$
Acquired From:
North Dakota Dealer
Difference / Subtotal
$
Number (if applicable)
$
Tax (5% of Difference / Subtotal)
First Lienholder (title will be mailed to first lienholder)
$
Abandoned Vehicle Disposal fee
($1.50)
$
Title Fee
($5.00)
Mailing Address
$
License Fee
City
State
Zip
$-
License Plate Credit Amount
$
Plate Transfer Fee
($5.00)
Second Lienholder
$
TOTAL FEES DUE:
Mailing Address
Year and Make of Trade-In
City
State
Zip
VIN of Trade-In
Tax Exempt (see
NOTE: A guide published by the automobile
instructions on reverse)
industry will be used to check values.
VI.
NDCC Chapters 39-04 and 39-05. Applicant certifies this vehicle will be
X
insured as required by law. The applicant, under penalties of law and as
Signature - this is my legal signature
Date
rightful owner of the vehicle described on this application declares that the
information set forth is correct.
X
If vehicle is company owned, company name and title of authorized agent
signing the application must be noted.
Signature - this is my legal signature
Date
ATTENTION TRUCK OWNERS HAULING HAZARDOUS MATERIALS:
PENALTY: Any person making any false statement on this application for
I declare, with my signature on my registration application that I am
license or title for which another penalty is not specifically provided is guilty of
knowledgeable of the Federal or State Motor Carrier and Hazardous
a class B misdemeanor.
Materials Safety Regulations.
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