Mvd 10002 Form – Fill Out and Use This PDF

STATE OF NEW MEXICO

TAXATION & REVENUE DEPARTMENT

- PLEASE READ

Title Number

MOTOR VEHICLE DIVISION

DIVISION

IMPORTANT

APPLICATION FOR VEHICLE

INFORMATION

TITLE AND REGISTRATION

USE ONLY

ON REVERSE SIDE -

MVD-10002 REV. 09/09

Vehicle Identification Number

Year

Make

Model / Series

Number

Color(s)

MAJOR

MINOR)

of Liens

Secondary ID Number

Wt./Wheels

First Year Reg.

Date of Issue

Type of Title 01 - First Time

04 - Duplicate

02 - Title Transfer

05 - No Fee Corr.

03 - Lien Release

11 - Non-Negotiable

Name and Mailing Address of Registered Owner(s)

DGVW

Cyls.

Body Type

Type of Fuel

(G) -Gasoline (D)-Diesel

Odometer *

(L)-Liquified (O)-Other

License Plate Number(s)

Vehicle Brand

Vehicle Class

Title

Use

Previous Title No. and State

Date Purchased

Fleet Number

Commercial Vehicle

"2290"

2-Year Registration

# of Passengers

# of Doors

# of Seats

1st Reg. Owner's Social Security / Employer Identification / CRS No.

1st Reg. Owner D.O.B.

N.M. Driver License No.

N.M. Veteran Cert. No.

FIRST LIEN

File Date

Maturity Date

SECOND LIEN

File Date

Maturity Date

HOLDER

HOLDER

Name and Address

Name and Address

Canceled Plt. No.

Dealer Lic. No.

Mobile Home Size

Cnty.

Approximate Location (Mobile Home)

Suspended By:

Trade-In VIN (If Applicable)

REG. EXPIRATION:

MONTH

DAY YEAR

Cleared By:

Residence Address If Different Than Mailing Address

Reg. Sticker Number:

Sale Price:

IMPORTANT: THERE IS A PENALTY CHARGE

Less Trade-In:

FOR FAILING TO RENEW BY THIS DEADLINE.

*ODOMETER DISCLOSURE STATEMENT

Net Difference:

FEDERAL AND STATE LAW REQUIRES THE TRANSFEROR (SELLER) OF A VEHICLE TO STATE THE ODOMETER MILEAGE UPON TRANSFER OF

OWNERSHIP. ANYONE CONVICTED OF A FRAUDULENT ODOMETER STATEMENT WILL BE SUBJECT TO FINES AND / OR IMPRISONMENT.

90

Net Excise Tax:

I hereby certify that the ODOMETER READING of the vehicle described above is: ______________________________ (no tenths) miles and

that to the best of my knowledge stated mileage is (check one of the following):



WARNING: NOT THE ACTUAL MILEAGE -ODOM-

Registration:

 THE ACTUAL

 MILEAGE IN EXCESS OF

*Mileage Codes

MILEAGE (AM)*

MECHANICAL LIMITS (EL)*

ETER DISCREPANCY (NM)*

X

52

Late Reg. Penalty:

_______________________________________

_________________

Printed Name of Seller

Signature of Seller

Date of Statement

Vets. Allowance:

_______________________________________

X

_________________

51

Printed Name of Purchaser

Signature of Purchaser

Date of Statement

NOTICE: Payment of the registration fee and acceptance of the application by the Motor Vehicle Divi-

Net Registration:

sion constitutes an affirmation that the applicant for title and registration has complied with the require-

ments of the Mandatory Financial Responsibility Act, NMSA 1978 §66-5-201 through 66-5-239.

Spec. Plate Fee:

APPLICANT CERTIFICATION: I (We) hereby certify that the information given herein is true and correct

Admin. Fee:

to the best of my (our) knowledge and affirm that I (we) have complied with the requirements of the

61

Mandatory Financial Responsibility Act with respect to this vehicle. SEE REVERSE SIDE.

_______________________________________

X

_________________

Transaction Fee:

_________________________________________________

55

Printed Name of 1st Registered Owner

Signature of 1st Registered Owner

Date of Statement

_______________________________________

X

_________________

70

Late Transfer Fee:

Printed Name of 2nd Registered Owner

Signature of 2nd Registered Owner

Date of Statement

The Division is not responsible for false or fraudulent statements the applicant/registered owner makes in connection with this application, nor is the Division liable

72

Duplicate Title Fee:

for lien recording errors. The registered owner must notify the Division of any errors contained in the title and registration issued pursuant to this application.

NCIC Check by

TOTAL

FEES:

ACCEPTED BY: Signature of M.V.D. Employee: _______________________________________________________ Date: ______________

$