How to fill out Vermont VT-004

The form for a Vermont certificate that is lost, stolen, destroyed, mutilated or illegible. It matters to a seller for a reason that has nothing to do with tidiness: you cannot assign a certificate you do not have, so on a titled Vermont car this is the step before the sale rather than after it. Two of its rules decide whether you can use it at all. If a lien is still in effect only the lienholder may apply. And there is an online route, but only where the last issued title had no liens listed on it.

Written against VT-004 (08/2024), issued under 23 V.S.A. s. 2022, duplicate certificate, affirmed under penalty of perjury per 23 V.S.A. s. 202 and s. 4110. Do not start a sale on the strength of a replacement application. Until the new certificate is in your hand there is nothing to assign, and the department publishes no processing time for one.

Two documents, and they are not the same thing. Take the blank VT-004 from the dmv.vermont.gov copy so you get the revision that is current today, then print our VT-004 guide and keep it beside you while you fill theirs in.

Step 1 · the form itself Blank VT-004 — Replacement Title Application PDF at dmv.vermont.gov · new tab Step 2 · how to fill it in Our filled-in VT-004 guide PDF · print and keep beside you

Filled in

What a completed one looks like

This is the actual VT-004, rendered from the PDF the Vermont Department of Motor Vehicles, Agency of Transportation publishes and completed end to end: letterhead, every field, and the blocks at the foot.

Amber — you write it
Grey — not yours to fill
Numbered — explained below

A completed Vermont Replacement Title Application, form VT-004, for a 2013 Toyota Tacoma whose certificate was lost: the owner named as Bellerose, Winslow J. of Newport with a Vermont licence number and date of birth, the vehicle described by plate GBD517, model year 2013 and make Toyota, the vehicle identification number 5TFTX4CN0DX027641, a mileage of 141,208 with the actual-mileage certification, the lienholder block empty, the LOST box ticked in the declaration and the salvage question answered NO. — Rendered from the department's own PDF and completed the way an owner with no lien completes it. The lienholder band and the lienholder signature line at the foot are greyed because they belong to somebody else - and on a car whose loan is still live, the whole application does. Every person and number in this sample is invented, and the VIN matches nothing on the road.

Field by field

Every line, in the order you meet it

1
You fill this in
Vehicle is Owned or Leased
A tick at the very top of the sheet, before anything else.
Watch out: A leased vehicle is not yours to replace a title for. If this is a lease, the lessor is the titled owner and the application is theirs.
2
You fill this in
Name (Owner/Lessee) and License #
Your name as the missing certificate printed it, with your Vermont credential number.
Watch out: If your name has changed since the certificate was issued, fill in the previous-names box. The department is matching a record, not meeting you for the first time.
3
You fill this in
The two address lines
Where you get mail and where you live, each with city, state and ZIP.
Watch out: The replacement is posted, and it is posted once. Check the mailing line twice.
4
You fill this in
Plate/Registration # and its expiration
Taken off the registration certificate, which is the document you still have.
Watch out: The registration also carries the title number and a note that a certificate was issued. It is the best evidence available when the certificate itself is gone.
5
You fill this in
Serial Number (VIN)
Seventeen characters, from the registration or from the windscreen plate.
Watch out: Compare the two before you send it. A car whose registration and VIN plate disagree is a VT-010 verification, not a replacement title.
6
You fill this in
Mileage, and its certification
Whole numbers, with one of the three boxes ticked.
Watch out: This reading gets printed on the replacement, so it becomes the number the next buyer sees on the face of the certificate. Take it off the dashboard on the day you sign.
7
The lienholder fills this in
The lienholder block
Completed where a lien is printed on the certificate being replaced.
Watch out: If that lien is still in effect, stop. Only the lienholder can make this application, and they have to sign it.
8
You fill this in
The Mail to block
An override for where the replacement is posted, used only where it should not go to the address on the title.
Watch out: The form also asks you to enclose a self-addressed envelope if you use this block. It is easy to miss and it delays the whole thing.
9
You fill this in
LOST, STOLEN, DESTROYED, MUTILATED or ILLEGIBLE
One tick, certifying what happened to the original.
Watch out: Mutilated and illegible both require the damaged certificate to travel with the form. Lost and stolen do not, for obvious reasons.
10
You fill this in
Signature of Current Titled Owner and Co-Owner
Every owner on the certificate, with the date.
Watch out: More than two owners means more than one application form. The department says so in its own instructions and does not make an exception.

At a glance

What goes where

On the form	What to put in it
Vehicle is Owned or Leased, and Email or phone	Two ticks and a contact line, at the top rather than the bottom.
Owner/Lessee: Name, License #, Address where you get Mail, Address where you live	Your block, with separate mailing and residential lines each carrying their own city, state and ZIP.
If name has changed, list previous name(s) - and, beside it, Date of birth	The box that reconciles a certificate issued under a former name with the licence you will show.
Co-Owner/Lessor: the same block again	Filled in wherever the certificate names two, because all owners must sign for a replacement.
Must Indicate Rights Of Survivorship - Spouses, Joint Tenants, Tenants In Common, Partners (business) or TOD	Compulsory on a certificate in more than one name, under a heading printed in red.
Plate/Registration # and its expiration date, then Model Year and Make	Four boxes taken from the registration rather than from the missing certificate - which is the point, because the registration is the document you still have.
Vessel Length (if boat) and Body/Hull Type (if boat)	Blank on a car, and the reason the fee block lists two different figures.
Serial Number (VIN)	Seventeen characters, from the registration or from the vehicle itself.
Mileage (No Tenths), one of Miles, Km or Hours, and one certification of the three	A full odometer disclosure. A replacement certificate is a new certificate and it will carry this reading.
Lienholder: Name, Address, Date of Lien, City, State, ZIP, and License #/Date of birth if individual	Completed where a lien is printed on the certificate being replaced - and if that lien is still live, the lienholder is the applicant.
Mail to: Name and Address	An override. The replacement is posted to the lienholder or, failing that, to the owner; this block sends it somewhere else.
Declaration: LOST, STOLEN, DESTROYED, MUTILATED, ILLEGIBLE	One of five ticks, and the reason the department wants a mutilated or illegible certificate enclosed with the form.
Is this a salvaged, totaled or rebuilt vehicle? YES / NO, and SALVAGED / TOTALED / REBUILT	Two rows of ticks, because the replacement has to reproduce every brand the original carried.
Signature of Current Titled Owner and Co-Owner, with Date	All owners. The instructions say so and add that more than two owners means additional applications.
Signature of Lienholder (not a lien release), and Printed name of Lienholder	A signature line with the department's own warning built into its label.

What gets this one rejected

•An owner applying while a lien is still in effect. The instruction is flat: only the lien holder may apply for a replacement and must sign the application.
•A mutilated or illegible certificate not enclosed. The form says any mutilated or illegible certificate MUST accompany it.
•A certificate with erasures or alterations sent in without an explanation. That case needs a Title Alteration Statement, form VN-020, saying why the alterations were made.
•An attempt to add or remove a lien or a name on this form. It cannot do either - the department sends you to VT-019 for a lien and requires a release to remove one.
•One signature on a two-owner certificate. All owners must sign for a replacement title.
•The wrong fee. Vessel, ATV and snowmobile titles are $27.00; all other titles are $42.00; each lien is $14.00 on top.

Rules that decide whether it is accepted

•The online route exists but is narrow. The department's replacement-title page says you can request one online only if the last issued title had no liens listed. The option appears in myDMV on the vehicle's own block, alongside Renew Registration and Mark Vehicle Sold.
•A paid-off lien has to be cleared first. In person or by post, if the last issued title had a lien listed, you will need proof that the lien has been released - a VT-008 or a letter on the lender's letterhead carrying the make, model, year, identification number, owner's name and lienholder's signature.
•Issuing a replacement kills the original. Section 2022(d) requires the Commissioner to revoke the original certificate when a duplicate is issued, and subsection (c) requires anyone who then finds the original to surrender it promptly.
•The replacement is not posted to you by default. It goes to the first lienholder named on it, or to the owner if there is none - and to somewhere else only if you complete the Mail to block.

Every line here was read off VT-004 (08/2024) itself — the PDF is here — and off the Vermont Department of Motor Vehicles, Agency of Transportation pages. This is plain-language help with a form, not legal advice, and where our wording and the agency's differ, theirs governs.

Back to all Vermont seller paperwork, or what selling a car in Vermont involves.

How to fill out Vermont VT-004

What a completed one looks like

Every line, in the order you meet it

Vehicle is Owned or Leased

Name (Owner/Lessee) and License #

The two address lines

Plate/Registration # and its expiration

Serial Number (VIN)

Mileage, and its certification

The lienholder block

The Mail to block

LOST, STOLEN, DESTROYED, MUTILATED or ILLEGIBLE

Signature of Current Titled Owner and Co-Owner

What goes where

What gets this one rejected

Rules that decide whether it is accepted

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