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NEW OWNER’S LAST NAME (OR COMPANY NAME) FIRST NAME M.I.
1
DO NOT GIVE PO BOX (Include Street Number and Name) CITY OR TOWN STATE ZIP CODE COUNTY
Apt. No.
A VEHICLES AND MOTORCYCLES B BOATS ONLY How was the boat obtained? New Used Leased
FOR OFFICE USE ONLY How was the vehicle obtained? HULL IDENTIFICATION NUMBER
MILEAGE BRAND New Used Lease Buyout
Salvage Leased
VEHICLE IDENTIFICATION NUMBER
YEAR MAKE LENGTH
Feet Inches
4 LIEN INFORMATION - To be completed only by a NYS-registered vehicle, boat, or trailer dealer - DO NOT USE FOR MFH
LIEN FILING CODE (Assigned by DMV) LIENHOLDER NAME AND ADDRESS
NYS REG
DEALER
ONLY
6 OWNER CERTIFICATION: I state that the information I have given is true to the best of my knowledge. If the vehicle, motorcycle, trailer or boat
is currently registered in another name, I authorize such registration. If there is a co-owner, BOTH signatures are required.
1. ( )
New Owner Sign Name in Full Date Daytime Telephone Number
2. ( )
New Co-Owner Sign Name in Full Date Daytime Telephone Number