| Name(s) and mailing address | The buyer(s)/owner(s) of the following motor vehicle make application - full name, then number, street, city or town, county, state and zip code across one ruled row. Two buyers both go here if the new title is to carry two names. |
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| Vehicle description | Make, year, V.I.N., style of body and weight, with the weight boxed for passenger vehicle only against a TRUCKS requested (GVW) alternative. Then the odometer reading, no tenths, and the title brands row - RECONSTRUCTED or OTHER. |
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| Purchase price, trade-in, net cost and 6% sales tax | Four boxes across the sheet's middle. The bracketed condition under them is the whole trade-in rule: credit allowed only on vehicles titled in West Virginia and the tax paid thereon by applicant. |
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| Trade-in description | Two numbered rows - make, year, VIN/serial number and the West Virginia title number of whatever was traded. Private sales leave both empty; the arithmetic above then runs on the price alone. |
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| Registration plate transferred from | The buyer's old vehicle: make, weight, VIN, title number and license plate number, with an instruction to send a copy of the registration card both sides. This is where the buyer's own plate follows them onto the newly bought car. |
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| Liens and encumbrances | Two numbered lien blocks, each with name, amount, lender code, mailing address, kind of lien - C/S/C, D/T or S/A - and date. What is written here is what the new certificate will carry on its face. |
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| Insurance and certification | Name of insurance company, agent, policy number and NAIC number, beside the statement that there is a motor vehicle liability policy in effect on the described vehicle and that the statements are true and correct under penalty of false swearing, citing 17A-9-1, Fraudulent Applications. Two (X) signature lines, with the rule printed above them: if the title reads AND, both signatures of owners must appear. |
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| Dealer certification | A block a private sale leaves entirely blank: acquired-from and sold-to dates, a certification that the sale price, trade-in and net cost are true and that the Federal Odometer Regulation has been satisfied, the dealer's own odometer statement with its two exception ticks, and the dealer name, address, signature and license number. |
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| The reverse - instructions, fee table and checklist | Blue or black ink only, no cash, the $10.00 service charge for a dishonoured cheque, and the fee table: title fee $15.00 (this fee is required), lien fee $10.00 per lien, license plate transfer fee $10.50, 6% sales tax with the note that all sales under $500.00 must pay $30.00 instead, and registration by class from the fee brochure. The checklist closes with the Charleston post box the packet goes to. |
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