Mv2119 – Fill Out and Use

AVehicle Owner Information

Owner/Co-owner: The names on the replacement title

will match what is currently in our records. “And” means all owners must sign the title to transfer ownership. “Or” means only one owner must sign the title.

Opt Out: You may remove your name(s) from mailing lists that contain 10 or more individual names by checking the box. Businesses are not eligible for opt out.

Social Security Number and Driver License Number: If you are applying as an individual, you are required to provide your Social Security Number (SSN), under s.342.06(1)(eg) Wis. Stats. If you have a WI driver license, you may provide that number instead of your SSN. Under the Social Security Act, 42 USCs. 405,(c) (2)(C) (i), the department and other state and federal agencies may use the SSN for purposes authorized by law. FEIN: Federal Employer Identiication Number is required for corporations or other non-individual owners.

DFees

Replacement Title Fee is required to replace a

lost, stolen or mutilated Wisconsin title.

Loan Filing Fee is required if you are adding a new loan to the vehicle at the time of application for a replacement title.

Counter Service Fee is required if you apply in person at a DMV Customer Service Center.

Processing Fee may be required if you are adding a loan and the Secured Party is not iling electronically; add $5 for DMV processing. Nonexempt Secured Parties must pay an additional $20 surcharge that may not be charged to the customer.

EVehicle OWNER Certiication

Only the owner may apply for a replacement title if there are no liens on the vehicle or the lien was iled before July 30, 2012. Complete the permission to mail title certiication section if the replacement title should be sent to someone other than the

vehicle owner name and address shown above in section A.

BVehicle Information

The vehicle identiication number and plate number are necessary to process your application.

CLoan Information: For any new loans you may be adding, contact the lender for the correct information, including complete mailing address. You will receive a Conirmation of Ownership and your title will be sent to the irst lender on the title.

If you are listed on the Department of Children and Family Services (DCF) docket for unpaid child support, the title will be delivered to their oice (if there are

no other liens on the vehicle) and you will receive a

Conirmation of Ownership. If you have questions about child support, contact DCF at: (608) 267-3905.

FVehicle LIEN HOLDER Certiication

Only the lien holder may apply for the replacement title if the lien was iled on or after July 30, 2012. Lien holders who received an electronic title cannot apply for a replacement using this form. They must contact their service provider for assistance. Complete the name and address section if the replacement

title should be sent to someone other than the lien holder.

Release of Non-Exempt Information: Under Wisconsin open records law, the Wisconsin Department of Transportation must provide information from its records to requesters. If you do not want your name and address included in requests we receive for ten or more records, you may ask the department

to withhold your name and address from those lists. Form

MV3592 is available at DMV Customer Service Centers and at: http://wisconsindot.gov/Pages/global-footer/formdocs/ default.aspx.

ADA: The Wisconsin Department of Transportation complies with the Americans with Disabilities Act.

REPLACEMENT TITLE APPLICATION

Wisconsin Department of Transportation

DO NOT WRITE ABOVE THIS LINE. Complete form using BLUE or BLACK INK.

Title No. – New License Plate No.

Amount Received – Document No.

Check Cash

1 2 3

4 5

6 7 8 9

OR

1 2 3 4

5 6 7 8

9 10 11 12

13 14

OR

1 2

3 4 5 6 7 8 9

Co-Owner Name (if any) (Last, First, Middle Initial) (check one)  OR  AND

Street Address (include PO Box if applicable)

Birth Date

M M

City

D

D

Y

Y Y Y

Co-Owner Social Security # or Driver License # or FEIN Number – Required

1 2 3 4 5

6 7 8 9 10 11

12 13 14 15 16 17

License Plate Number

1 2 3 4 5 6 7 8

Section D – Fees

Section E – Vehicle OWNER Certiication

By signing below, I (we) certify that my (our) title is lost, stolen or mutilated and is not currently held by the lien holder. The information and statements on this application are true and correct.

Permission to Mail Title Certiication

If you would like the title mailed to a diferent address, please ill in the name and address below. I, the owner of the above vehicle, give permission to mail the replacement title to the following:

Name of Title Recipient

Address of Title Recipient

CityState ZIP Code

X

(Owner Signature)(Date – m/d/yyyy)

X

STOP Did you... Enclose a signed check? Sign the application? Make a copy for your records?

MAIL the application and check to:

WI Dept. of Transportation

PO Box 7949, Madison WI 53707-7949 Make Check Payable To: Registration Fee Trust

Any title with a lien (loan) listed as of July 30, 2012, will be sent to the lien holder. Please visit http://wisconsindot.gov/Pages/online-srvcs/other- servs/lien-search.aspx to verify lien list dates.

Section F – Vehicle LIEN HOLDER Certiication

Wisconsin titles issued electronically to the lien holder cannot be issued a paper replacement title. See reverse side for more information.

By signing below, we certify that we are requesting the title on our behalf as the current holder of this title and statements on this application are true and correct.

Name of Lending Agency(s) or Person(s)

Street Address (include PO Box if applicable)

If you would like the title sent to a diferent address, please ill in the name and address below. We, the lien holder of the above vehicle, give permission to mail the replacement title to the following:

Name

Address

X