Dpsmv 1968 Form PDF Details

Did you know that the Department of Public Safety, Motor Vehicles has a form called Dpsmv 1968? This form is for recording driver license or identification card transactions. Transactions that are recorded on this form include issuance, renewal, change of name or address, duplicate, corrected and expired cards. The information entered on this form is transmitted to the Central Registry which maintains driver records. In order to complete this form accurately, you will need to gather certain information beforehand. For instance, the full name as it appears on your driver license or identification card, date of birth and social security number. failure to provide accurate information could result in errors being made on your record. So be sure to have all your documentation ready before filling out this form. Thanks for reading!

QuestionAnswer
Form NameDpsmv 1968 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslouisiana dpsmv title application pdf, louisiana dpsmv title application, louisiana dpsmv1968 department public safety auto form, la title company application pdf

Form Preview Example

State of Louisiana

Department of Public Safety and Corrections

Office of Motor Vehicles

 

 

 

 

P. O. Box 64886

 

 

 

 

 

Baton Rouge, Louisiana 70896-4886

 

□NEW □RENEWAL

Auto Title Company Application

 

 

 

 

 

 

 

A SEPARATE APPLICATION MUST BE SUBMITTED FOR EACH LOCATION AND EACH CO-OWNER

 

 

 

PLEASE TYPE OR PRINT

 

 

 

Business Name (must read exactly the same on both the bond and on the contract)

 

 

 

 

 

 

 

 

 

 

 

Physical Address of Business

 

 

 

 

Parish

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

Phone No.

 

 

 

Fax No.

 

 

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Email Address: (Mandatory)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Previous License No. /Authorization No. (if applicable)

 

 

Bond No.

 

 

 

 

 

 

 

 

 

 

 

Name of Surety Company

 

 

 

 

Surety’s Phone No.

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

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1.Has any license ever been denied, revoked or suspended by this Department to you or any of the principals of the partnership or corporation? Yes _____ No _____ if yes, give details below.

2.Have you ever been on probation or sentenced to jail/prison as a result of a felony conviction or guilty plea to a felony charge? Yes ____ No ____ If yes, give the law enforcement authority (city police, sheriff, FBI, etc.) the offense, date of the offense, place and disposition of case. Use back of this document if additional space is needed.

3.You are required to submit three (3) references, at least one of which must be from a current/former customer.

4.PLEASE READ THIS APPLICATION, ALL ATTACHMENTS AND THIS CERTIFICATION PRIOR TO

SIGNING THIS APPLICATION BEFORE A NOTARY PUBLIC

I HEREBY CERTIFY THAT THE STATEMENTS MADE HEREIN ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT I AM FAMILIAR AND WILL ABIDE WITH THE PROVISIONS OF ALL THE LAWS, RULES AND REGULATIONS UNDER WHICH THIS REQUEST IS MADE.

OWNER’S SIGNATURE ________________________________________________________________DRIVER’S LICENSE #____________________

OWNER’S PRINTED NAME _____________________________________________________________

SWORN TO AND SUBSCRIBED BEFORE ME THIS ________________________________ DAY OF _____________________________, 20 _______

NOTARY PUBLIC SIGNATURE __________________________________________________________________________________________________

NOTARY PUBLIC PRINTED NAME & NUMBER _________________________________________________________ /____________________________

FEE: A check/money order in the amount of $200.00 must accompany request. If auto title companyhas more than one location, a separate request and a fee of $50.00 must be submitted for each additional location.

$

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MVCA Officer

Dollar Amount Received

Date Processed

DPSMV 1968 (R 02/2012)

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louisiana dpsmv title application pdf completion process shown (stage 1)

2. The next part is usually to complete all of the following fields: Previous License No Authorization, Address City, Suretys Phone No, State, Zip Code, Has any license ever been denied, partnership or corporation Yes No, Have you ever been on probation, You are required to submit three, PLEASE READ THIS APPLICATION ALL, SIGNING THIS APPLICATION BEFORE A, and I HEREBY CERTIFY THAT THE.

How one can complete louisiana dpsmv title application pdf portion 2

3. In this part, check out I HEREBY CERTIFY THAT THE, MVCA Officer DPSMV R, Dollar Amount Received, and Date Processed. All these must be completed with utmost awareness of detail.

How you can fill out louisiana dpsmv title application pdf stage 3

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