Application for Kentucky Certificate of Title Registration 2024-2026

Kentucky Transportation Cabinet Division of Motor Vehicle Licensing APPLICATION FOR KENTUCKY CERTIFICATE OF TITLE OR REGISTRATION Check the type of application desired If Duplicate is checked the original Certificate of Title is Vehicle Identification Section Duplicate Lost Title Only Destroyed Transfer Damaged First Time Illegible TC 96 182 01/2023 Salvage Other Classic CERTIFIED INSPECTOR SECTION I Certified Inspector Print Name VIN of Make County Phone No. do certify under the penalty provisions of KRS 186A. 115 4 d that I have physically inspected the vehicle described herein to be roadworthy and that the supporting documents Year Body Style Model Model No* Color are consistent with the vehicle description* THE VEHICLE HAS AN ODOMETER READING OF Motor No* Cylinders if motorcycle TITLE BRAND DISCLOSURE Check appropriate block if Truck Weight Rebuilt Vehicle THE VEHICLE IDENTIFICATION NUMBER IS INSPECTION REQUESTED Water Damage If block is checked and title does not include brand provide jurisdiction BY if previous brand was and title number NO TENTHS OWNER DRIVER LICENSE NO. STATE issued* INSPECTOR NO. DATE ODOMETER DISCLOSURE CAUTION READ CAREFULLY BEFORE YOU CHECK A BLOCK 49 USC Sec* 32705 and KRS 190. 300 require that you state the mileage upon transfer of ownership* Failure to complete or providing a false statement may result in fines and or imprisonment. I certify to the best of my knowledge that the odometer reading is the actual mileage of the vehicle unless one of the following statements is checked* no tenths Odometer Reading 1. The mileage stated is in excess of its mechanical limits. 2. The odometer reading is not the actual mileage. WARNING ODOMETER DISCREPANCY. TOTAL CONSIDERATION AND TRADE-IN INFORMATION Sale Price Trade In Net Cost VIN No* Tax Title No* Date of Sale Seller and buyer certify pursuant to the penalty provisions of KRS 190. 990 5 that each has supplied true and correct total consideration information to the best of their knowledge and belief in this document including the above affidavit. JOINT OWNERSHIP OR AND NOTE If neither box is checked the Title Transfer shall require both signatures. NAME OF SELLER DEALER NO. NAME OF OWNER/BUYER S*S* KyDL or Govt* issued BIRTH MO. STREET ADDRESS PHONE NO. CITY COUNTY STATE ZIP EMAIL ADDRESS I have have not applied for a loan in connection with the vehicle described herein and if not I will LESSEE NAME OR OTHER FIRST LIENHOLDER LESSEE ADDRESS ADDRESS COUNTY LIEN TO BE FILED IN SELLER S SIGNATURE will not apply for a loan within 30 days of this application* OWNER/BUYER S SIGNATURE S DATE OF TRANSFER Attesting Official Title Sworn or affirmed before me this day of 20 My commission Expiration COUNTY CLERK USE ONLY TYPE APPLICATION DATE OF ISSUANCE TITLE NO. PLATE NO. I certify subject to the penalty provisions of KRS 190. 990 5 that I have reviewed this application and the documents supporting it and that the same are present and consistent with this application that I received the application on the date and time indicated hereon and that fees were collected as indicated* I further certify that the required information has been entered into the automated vehicle identification system AVIS.