Dmv Cta 001 Form – Fill Out and Use This PDF

GOVERNMENT OF THE DISTRICT OF COLUMBIA

DEPARTMENT OF MOTOR VEHICLES

95 M ST SW, WASHINGTON DC 20024

LEASING AGENT TITLE/TEMPORARY REGISTRATION AND TAG APPLICATION

Please PRINT the information on this application.

This application is to be used by Leasing Agents. Vehicle is titled and registered in DC to either DC Company or non-DC Company. The leasing agent will be on the title as lessor. The DC or non-DC company will be on the registration as lessee, and the leasing agent will be on the registration as primary lessee.

TYPE OF SERVICE

 Temporary DC Registration

 New Title/New Tags

 Reciprocity (Take Home)  Duplicate Title

 Temporary Tag

 One Year Registration

 One Year Registration with Residential Parking Permit (RPP)

LEASING AGENT NAME (Vehicle will be title in Leasing Agent’s name)

FEDERAL EMPLOYEE IDENTIFICATION #

LEASING AGENT ADDRESS

ADDRESS

UNIT

CITY/STATE

ZIP CODE

PRIMARY COMPANY/LESSEE FULL NAME

FEDERAL EMPLOYEE IDENTIFICATION #

ADDRESS

UNIT

CITY/STATE

ZIP CODE

COMPANY/LESSEE FULL NAME

FEDERAL EMPLOYEE IDENTIFICATION #

ADDRESS

UNIT

CITY/STATE

ZIP CODE

VEHICLE INFORMATION

MAKE

YEAR

BODY

TITLE BRAND

UNLADEN WEIGHT

VEHICLE IDENTIFICATION NUMBER

ACTUAL MILEAGE

 I certify to the best of my knowledge that actual mileage is__________________

LIEN/SECURITY AGREEMENT INFORMATION

LIEN DATE:

(A Lien/Security agreement must accompany this application if applicable. If a lien exists, the title will be mailed to the Lien holder)

Name of Lien Holders

Lien Holders Address

Lien Amount

INSURANCE COMPANY INFORMATION (Current Proof of Insurance must accompany this application)

Name of Insurance Company

Policy Number

Policy Effective Date

Expiration Date

I/we certify that the above information is true and correct to the best of my/our knowledge, information, and belief. Any person(s) using a fictitious name or address and/or Knowingly making any false statements on this application is in violation of DC Law and subject to a fine of not more than $1,000 or 180 days imprisonment or both.

(DC Official Code § 22-2405)

(Must be signed by Owner(s), Officer of Corporation, Partner in Partnership or Person with accompanying power of attorney)

OFFICIAL DMV USE

EXCISE TAX

SELLING PRICE (New Vehicles)

NADA BUSINESS/FAIR MARKET VALUE (Used Vehicle

s)

$

$

$

TITLE # OR TAG# (HARD OR TEMPORARY)

Approval by DMV Examiner

Date

Operator’s Number

If you have questions, please contact Processing Center Manager at 202-729-7041.

To report waste, fraud, or abuse by any DC Government Agency or official, call the DC Inspector General at 1-800-521-1639.

DMV-CTA-001 Rev. 09/26/2013