APPLICATION TO TITLE/REG. A VEHICLE
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Driver and Vehicle Services Division
445 Minnesota St., St. Paul, MN 55101-5185
Phone: 651-297-2126 TTY: 651-282-6555
drive.mn.gov
VALIDATION AND
OFFICE USE ONLY
PLATE NUMBER |
STICKER NUMBER |
YEAR |
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Contact Phone Number for Customer |
WEIGHT STICKER NUMBER/MOTORCYCLE ENGINE NO. |
A |
VEHICLE IDENTIFICATION NUMBER |
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MODEL YEAR |
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MAKE |
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MODEL |
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BODY STYLE |
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VEHICLE COLOR |
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VEHICLE TYPE |
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VEHICLE CLASS |
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VEHICLE USE TYPE |
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# PASS. |
FUEL TYPE |
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AUTO INSURANCE COMPANY |
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POLICY NUMBER |
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EXP. DATE |
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WEIGHT RATING
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DATE OF ACQUISITION |
USED |
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EMPTY WT. |
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# AXLES |
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ODOMETER DISCLOSURE STATEMENT. I (WE) CERTIFY THAT THE ODOMETER |
DAMAGE DISCLOSURE STATEMENT. TO THE BEST OF |
NOW READS |
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(NO TENTHS) MILES AND TO THE |
MY KNOWLEDGE, THIS VEHICLE: |
BEST OF MY KNOWLEDGE, THE ODOMETER MILEAGE IS: |
Has |
(CHECK ONE) SUSTAINED DAMAGE IN EXCESS |
Actual mileage |
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Has Not |
OF 80 PERCENT ACTUAL CASH VALUE. |
In excess of odometer's mechanical limits |
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Not actual mileage - WARNING ODOMETER DISCREPANCY
ASSIGNMENT: I (WE) CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS. I (WE) WARRANT TITLE AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO THE PERSON(S) NAMED IN SECTION D.
X
ALL SELLER'S SIGNATURE(S)
C IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT(S)? YES
IF YES, COMPLETE SECTION C.
FIRST SECURED PARTY (PRINT NAME)
For Additional Secured Parties, Attach Completed Form PS2017
If more than two owners, complete a separate attachment with the additional owner's information (must provide all info as below)
FIRST, MIDDLE, LAST NAME |
DRIVER'S LICENSE NUMBER / DEALER NUMBER |
DATE OF BIRTH |
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ADDITIONAL PURCHASER(S)/OWNER(S) FIRST, MIDDLE, LAST NAME |
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DRIVER'S LICENSE NUMBER |
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DATE OF BIRTH |
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RESIDENCE STREET ADDRESS |
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CITY |
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STATE |
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ZIP CODE |
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MAILING ADDRESS |
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You can elect to receive your registration renewals by email. If you select this option, paper renewal notices will not be mailed.
To elect this service please provide an email address for notices to be emailed to:
This section to be completed if under 18. I CERTIFY BY MY SIGNATURE I HAVE PURCHASED THE VEHICLE DESCRIBED ON THIS APPLICATION. CHECK ONE:
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I am 17 years old and have completed an approved |
I am an employed, emancipated minor and I have a Minnesota driver's license. |
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driver training course. |
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I am 17 years old and a high school graduate. |
When I was a resident of a foreign state, I was the duly registered owner of the automobile or |
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truck described on this application. (COMPLETE SECTION G) |
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1 of 2 |
PS2000A-47 (01/2021) |
G |
"A vehicle acquired by a Minnesota resident is subject to tax as soon as the vehicle is operated on a Minnesota street or highway. An automobile brought |
into Minnesota by a non-resident must be registered within 60 days; however, if the foreign state vehicle is not currently registered, the vehicle must be |
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registered immediately. Tax for a non-resident is calculated 60 days from date of residency or transaction date, whichever is first; or from the date vehicle |
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is first operated on a Minnesota road or highway." |
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WERE YOU A MINNESOTA RESIDENT |
IF NO, WHEN DID YOU BECOME A |
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IF YES, WHEN WAS THE VEHICLE FIRST OPERATED ON A |
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AT THE TIME OF PURCHASE? |
MINNESOTA RESIDENT? |
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MINNESOTA ROAD OR HIGHWAY? |
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YES |
NO |
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BASE VALUE/MSRP or GROSS WEIGHT |
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REGISTRATION PERIOD |
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From |
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Through |
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MN COUNTY/STATE VEH. IS KEPT |
Registration Quantity |
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FOR CLASSIC, COLLECTOR, STREET ROD & PIONEER, PLEASE INDICATE DESIRED NUMBER OF PLATES: |
One Plate |
Two Plates |
REGULAR LICENSE PLATE NUMBER OF THE OTHER VEHICLE OWNED OR LEASED BY YOU: |
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NOTE: TRAILERS AND TRUCKS REGISTERED ON A GROSS WEIGHT BASIS MUST BE REGISTERED AT A MINIMUM OF 1.25 TIMES THE EMPTY WEIGHT.
†FOR TRUCKS REGISTERED AT 78,000 OR HIGHER, MUST DECLARE THE NUMBER OF AXLES ON THE FRONT OF THIS APPLICATION.
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I |
PURCHASER'S MOTOR VEHICLE SALES TAX DECLARATION |
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1. Full purchase price |
$ |
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MN DEALER LICENSE # |
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ADMIN/REGISTRATION TAX |
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MN SALES TAX ACCOUNT # |
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PLATE FEE |
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2. Less trade-in allowance |
$ |
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CONTRIBUTION FEE |
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INTERNAL REV. CODE # (IRC) |
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complete item #6 |
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WHEELAGE TAX |
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$ |
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PRORATE ACCOUNT # |
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3. Net purchase price |
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PRORATE FLEET # |
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TECH SURCHARGE FEE |
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4. 6.5% of line 3 |
$ |
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PS VEHICLE FEE |
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I declare this tax exemption |
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TRANSFER TAX |
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5. Less tax paid to another state$ |
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ADDITIONAL FEES: |
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TITLE FEE |
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ELECTRIC VEHICLE SURCHARGE |
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NET SALES TAX DUE $ |
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LIEN FEE |
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EXPEDITED TITLE FEE |
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6. Trade-in was: |
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MV SALES TAX |
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FARM QUARTERLY FEE |
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MODEL YR. |
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MAKE |
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PLATE # |
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LEASE EXTENSION FEE |
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LATE TRANSFER PENALTY |
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SUB-TOTAL |
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VIN NUMBER |
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REINSTATEMENT FEE |
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STATE/DEPUTY FILING FEE |
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SALVAGE INSPECTION FEE |
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WITHOUT PROPER OWNERSHIP/TRANSFER DOCUMENTS (e.g., OUT-OF-STATE |
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CERTIFICATE OF TITLE), NO MINNESOTA TITLE WILL BE ISSUED. |
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SPECIAL PLATE TRANSFER FEE |
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TOTAL DUE |
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(Sales tax due when registered) |
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J |
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Tennessen Warning |
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What is the purpose of supplying the requested information? |
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•The information collected on this form is used to apply for a certificate of title pursuant to Minn. Stat. § 168A.02(1).
Am I required to provide the requested information?
•You must provide the information requested within ten days of the date of sale in order to obtain a certificate of title. See Minn. Stat. § 168A.10(2).
What will happen if I do not provide the requested information?
•If you do not provide the requested information, DVS will be unable to process your application for a certificate of title.
Who will have access to the requested information?
•DVS may disclose personal information when it relates to the operation or use of a vehicle or to public safety. The use of personal information relates to public safety if it concerns the physical safety or security of drivers, vehicles, pedestrians or property. Information on an individual provided to register a vehicle may be treated as provided by U.S.C. § 2721, and may be disclosed as required or permitted by that section. Information may be used, rented, or sold solely for bulk distribution by organizations for business purposes including surveys, marketing or solicitation. The registered owner may request, in writing, that their residence address or name and residence address be classified as "private data on individuals," provided the vehicle is not registered to a business. See Minn. Stat. § 168.346(3).
I (We) certify I (we) are of legal age, have purchased this vehicle subject to liens shown and no other. This vehicle is and will continue to be insured while operating upon the public streets and highways. The vehicle will be operated in compliance with the laws that apply to its class of registration. I (we) have received a copy of this application and all of my (our) declarations are true and correct. If applicable, I (we) have knowledge of Federal and State applicable to commercial motor vehicle operation, Minn. Stat. § 221, public service commission rules 1-48 and 49 U.S.C. §
390-399, and if a transporter of hazardous materials, 49 U.S.C. §§ 171-199.
You may disclose my information for any use in |
You may disclose my personal information for bulk |
response to requests for my individual driver or |
distribution for surveys, marketing or solicitations. |
motor vehicle record. |
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Signature
Signature
ALL PURCHASERS/OWNERS MUST SIGN
DO NOT SIGN UNTIL FORM IS COMPLETED IN ENTIRETY
2 of 2
DATE
DATE
PS2000A-47 (01/2021)