APPLICATION
MVT-12-1
R 10/11
ALABAMA DEPARTMENT OF REVENUE
MOTOR VEHICLE DIVISION – TITLE SECTION
P. O. Box 327640 • Montgomery, AL 36132-7640
Application For Replacement Title
Submit $15.00 Application Fee (non-
refundable) in certified funds payable to
Alabama Department of Revenue.
Do not send personal checks or cash.
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TYPE OR PRINT |
VEHICLE MUST BE CURRENTLY TITLED IN THE STATE OF ALABAMA |
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ONLY |
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http://www.revenue.alabama.gov/motorvehicle/forms.html |
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V |
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VEHICLE IDENTIFICATION NUMBER* |
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TRANS |
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YEAR |
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MAKE |
MODEL |
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CODE |
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MODEL |
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02 |
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A |
H |
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N |
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I |
F |
CYLS |
NEW USED DEMO |
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DATE OF PURCHASE |
NUMBER |
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COLOR |
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ODOMETER READING |
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CURRENT ALABAMA TITLE NO. |
C |
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L |
O |
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LIENS |
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E |
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OWNER(S) NAME MUST BE IDENTICAL AS APPEARED ON ORIGINAL TITLE
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NAME(S) (Last Name, First, Middle) |
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FELONY OFFENSE FOR FALSE ADDRESS |
DEPARTMENT USE ONLY |
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W |
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N |
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E |
CURRENT MAILING |
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R |
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ADDRESS |
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N |
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F |
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O |
CITY |
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STATE |
ZIP |
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NEW LIENS CANNOT BE RECORDED ON REPLACEMENT TITLES |
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(DO NOT ENTER IF LIEN RELEASED) |
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F |
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NAME |
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LIEN DATE |
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R |
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S |
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T |
ADDRESS |
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L |
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CITY |
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STATE |
ZIP |
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E |
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N |
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FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD |
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(DO NOT ENTER IF LIEN RELEASED) |
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E |
NAME |
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LIEN DATE |
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C |
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O |
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N |
ADDRESS |
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D |
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L |
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CITY |
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STATE |
ZIP |
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E |
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FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD |
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LOCATOR # |
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SPECIAL MAILING (IF NO LIENS LISTED HEREON): |
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OWNER(S) AUTHORIZATION FOR SPECIAL MAILING |
OWNER(S) MUST COMPLETE SECTION I IN ORDER TO HAVE TITLE SPECIAL MAILED |
REJECT TO: |
I (WE) HEREBY AUTHORIZE MY (OUR) CERTIFICATE OF TITLE TO BE MAILED TO (IF NO LIENS LISTED HEREON): |
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REASONS: |
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NAME |
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EXAMINER # |
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ADDRESS |
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ENCL: |
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CITY |
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STATE |
ZIP |
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APPLICATION FOR REPLACEMENT OF Alabama Title: Number |
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(IF KNOWN) Which was: |
(Mark ONE) Lost Stolen Mutilated Illegible |
or Other (reason) |
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Mutilated, illegible, or altered title must be submitted with this application.
CERTIFICATION STATEMENT
I understand that upon issuance of the “Replacement” certificate of title, the outstanding certificate of title is “Voided” and, if found, shall be returned to the Alabama Department of Revenue immediately. AS REQUIRED BY LAW, I further understand that the “Replacement” certificate will contain the legend, “THIS IS A REPLACEMENT CERTIFICATE OF TITLE AND MAY BE SUBJECT TO THE RIGHTS OF
A PERSON UNDER THE ORIGINAL CERTIFICATE OF TITLE.”
I certify that the above information is true and correct to the best of my knowledge and belief and I am aware that a false statement made on this application, with intent to defraud, is a felony violation under the
Alabama Uniform Certificate of Title and Antitheft Law (Title Law) (Sec. 32-8).
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Application by Recorded Lienholder |
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G |
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NAME OF LIENHOLDER — MUST BE TYPED OR PRINTED |
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SIGNATURE OF AUTHORIZED REPRESENTATIVE |
DATE |
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Release of Lien
The lien recorded on the original certificate of title is hereby released. I understand that by completing Section G and this release of lien (Section
HH), this firm WILL NOT appear on the Replacement title as LIENHOLDER.
SIGNATURE OF AUTHORIZED REPRESENTATIVE |
DATE |
*All VINs for 1981 and subsequent year model vehicles that conform to feder- al anti-theft standards are required to have 17 digits/characters.
Application by Titled Owner if No Lienholder
Was Recorded on Alabama Title
SIGNATURE OF OWNERDATE
*Enter U.S. Citizenship or Lawful Presence Document
Number (See back of form – include document): . . . . . . . . ___________
SIGNATURE OF CO-OWNERDATE
*Enter U.S. Citizenship or Lawful Presence Document
Number (See back of form – include document): . . . . . . . . ___________
*U.S. Citizenship or Lawful Presence is only required for individuals.
INSTRUCTIONS FOR COMPLETING THIS FORM APPEAR ON BACK
Instructions
Please verify that there is a current Alabama certificate of title in the name of the owner(s) listed on the front of this application, prior to submitting this application. Fees are not refundable or transferrable.
Section A – Vehicle Information
Section B – Owner Information – Enter the owner(s) name(s) exactly as it appeared on the original Alabama title that is being replaced. Enter the owner(s) current mailing address.
Section C – First Lienholder Information – Enter the name, lien date, and address of recorded lienholder. Do not enter lien- holder information if lien has been released. Note: new liens cannot be recorded on a replacement title.
Section D – Second Lienholder Information – Enter the name, lien date, and address of recorded lienholder. Do not enter lienholder information if lien has been released.
Section E – Special Mailing – Enter the name and address where the replacement title is to be mailed. Note: if the replacement title is to be mailed to someone other than the owner, the owner or his/her authorized representative must complete Section I in its entirety. Alabama law requires that replacement titles with lienholder(s) be mailed to the first lienholder. No special mailing is allowed.
Section F – Reason for Replacement Title – Mark the appropriate block to disclose the reason a replacement title is required. If the reason for the replacement title is other than lost or stolen, the title must be submitted with the MVT 12-1 form.
Section G – Application by Recorded Lienholder – The lienholder requesting the replacement title must complete Section G in its entirety.
Section H – Lien Release by Recorded Lienholder – The lienholder can release their lien by completing Section H.
Section I – Application by Titled Owner – The owner(s) of the vehicle or owner’s authorized representative must complete Section I unless the replacement title is being sent to the recorded lienholder.
Pursuant to the Beason Hammon Immigration Act, Act 2011-535, provide this office with a legible copy of any one (1) of the following documents, to verify citizenship or lawful presence in the U.S., along with the application for replacement certificate of title.
Acceptable U.S. Citizenship or Lawful Presence Documents:
1 – Valid Alabama Driver’s license (not expired) or Non-driver identification card.
2 – A valid (unexpired) driver’s license or nondriver’s identification card issued by another jurisdiction containing printed lan- guage that indicates the person has provided satisfactory proof of U.S. citizenship.
3 – Applicant’s birth certificate that verifies U.S. citizenship.
4 – Pertinent pages of the applicant’s U.S. valid or expired passport identifying the applicant and the applicant’s passport number.
5 – Applicant’s U.S. naturalization documents.
6 – Other documents or methods of proof of U.S. citizenship issued by the federal government pursuant to the Immigration and Nationality Act of 1952, and amendments thereto or any valid United States federal or state government issued identification document bearing a photograph or other biometric identifier if issued by an entity that requires proof of lawful presence of the alien in the United States before issuance.
7 – Applicant’s Bureau of Indian Affairs card number, tribal treaty card number, or tribal enrollment number.
8 – Applicant’s consular report of birth abroad of a citizen of the U.S.
9 – Applicant’s certification of report or birth issued by the U.S. Department of State.
10 – Applicant’s American Indian card, with KIC classification, issued by the U.S. Department of Homeland Security or a valid tribal enrollment card or other form of tribal identification bearing a photograph or other biometric identifier.
11 – Applicant’s final adoption decree showing the applicant’s name and U.S. birthplace.
12 – Applicant’s official U.S. Military record of service showing the applicant’s place of birth in the U.S.
13 – An extract from a U.S. hospital record of birth at the time of the applicant’s birth indicating the applicant’s place of birth in the U.S.
14 – Certificate of citizenship issued by the United States Citizenship and Immigration Services.
15 – A foreign passport with an unexpired United States Visa and a corresponding stamp or notation by the United States Department of Homeland Security indicating the bearer’s admission to the United States.
16 – A foreign passport issued by a visa waiver country with the corresponding entry stamp and unexpired duration of stay anno- tation or an I-94W form by the United States Department of Homeland Security indicating the bearer’s admission to the United States.