North Carolina Division of Motor Vehicles
Application for a Registration Plate or the Transfer of a Registration Plate
Non-Owner – Lessee
CHECK Appropriate Block/s (Application cannot be processed without certification of services)
Limited Registration Plate |
Truck Weight Desired ________________________________ |
Yes or No |
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For Hire Vehicle |
Plate No. Transferred _________________________________ |
Yes or No |
(List Plate Number and Expiration) |
I certify that all the above information is correct. ___________ (Customer’s Initials)
VEHICLE SECTION
YEAR |
MAKE |
BODY STYLE |
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SERIES MODEL |
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VEHICLE IDENTIFICATION NUMBER |
TYPE OF FUEL |
ODOMETER READING |
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ODOMETER BRAND |
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NAME OF OWNER (Lessor) |
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STATE IN WHICH VEHICLE REGISTERED |
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TERM OF LEASE |
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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.
LESSEE SECTION
Lessee 1 ID # _________________________ |
______________________________________________________________________________ |
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Full Legal Name of Lessee 1 (First, Middle, Last, Suffix) or Company Name |
Lessee 2 ID # _________________________ |
______________________________________________________________________________ |
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Full Legal Name of Lessee 2 (First, Middle, Last, Suffix) or Company Name |
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Residence Address (Individual) Business Address (Firm) |
City and State |
Zip Code |
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Mail Address (if different from above) |
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City and State |
Zip Code |
Vehicle Location Address (if different from residence address above) |
City and State |
Zip Code |
I, (We) certify that the described vehicle is leased from the owner and that this vehicle is to be used by me and that the information on the application is correct to the best of my (our) knowledge. I further certify the above listed vehicle is properly insured as required under G.S. 20-
309 by:
_____________________________________________________ |
_____________________________________________________ |
Insurance Company Authorized in N.C. |
Policy Number |
Signature of lessee ____________________________________________________________________________________________________
(Must be personally signed in ink by the lessee; if firm or corporation, by one of its authorized representatives, or, if in joint ownership, signature by each must be affixed)
LESSOR CERTIFICATION SECTION
As owner of the above described motor vehicle, I do certify that it has been leased to the person, firm or corporation whose name appears as lessee and further certify that it is being used by such lessee. Consent for the licensing of this vehicle in the name of the lessee is hereby given. The vehicle is properly insured, by the company listed above, as required by G.S. 20-309.
Signature of lessor __________________________________________________________________________________________________________________
(Must be personally signed in ink by the lessor; if firm or corporation, by one of its authorized representatives, or, if in joint ownership, signature by each must be affixed)
Instructions: A certificate of title must be vested and recorded in the name of the owner before a registration plate can be issued. If the vehicle is owned by a nonresident and is registered in a state other than North Carolina, the certificate of title, or registration certificate, must accompany this application. Proof of financial responsibility is required.