Rmv1 Form – Fill Out and Use This PDF

9. Type of Registration:

qPassenger qBus qTaxi

qLivery qCommercial

10. Vehicle Identiication Number:

qTrailer qAuto Home

qSemi-Trailer qMotorcycle

qOther________________

Owner

22. Owner # 1 License # / ID # / or SSN

23. Owner # 2 License # / ID # / or SSN

24.

EIN/FID # (see block 29)

If Sole Proprietor

provide SSN in #22

25. Owner # 1 Name (Last, First, Middle)

25a. Height

25b. Sex

26.

Owner

# 1 Date of Birth

_____ Ft _____ In

MALE

FEMALE

27. Owner # 2 Name (Last, First, Middle)

27a. Height

27b. Sex

28.

Owner

# 2 Date of Birth

_____ Ft _____ In

MALE

FEMALE

31.

Mailing Address

City

State

Zip Code

32. Residential or Corp/Co/Organization Address (see block 24 and 29)

City

State

Zip Code

33A. Lessee’s MA License Number or EIN/FID Number. If out-of-state Lessee, use SSN and date of birth.

33B. Lessee’s Name:

M M D D

Y Y

34.

Lessee’s Address, City, State, and Zip Code

Sales or Use Tax Schedule

56 A. SALE BY LICENSED MOTOR VEHICLE DEALER

Title

35. Date of Purchase

36. Odometer Reading

MA DOR-Registered Dealer EIN/FID # ______________________

Total Sale Price

$ ______________________

37.

qNew Vehicle

38. Title Type: qClear

qSalvage

qReconstructed

(adjusted for dealer’s discount and manufacturer’s rebate)

qUsed Vehicle

qOwner Retained

qTheft

qPrior Owner Retained

Less Manufacturer’s Excise

$ ______________________

39. Primary Salvage Title Brands:

40. Secondary Salvage Brand(s)

qRepairable

qParts Only

Net Sales Price

$ ______________________

Lienholder

41. Date of 1st Lien

42. Date of 2nd Lien

Less Trade-in Allowance For:

$ ______________________

I/we certify that all liens on this vehicle are listed below

43.

First Lienholder Code

44. Name

Yr __________

Make_____________ Model_______________

Trade-in VIN ___________________________________________

45.

Lienholder’s Address

Taxable Sales Price

$ ______________________

6.25% Sales Tax

$ ______________________

46.

Second Lienholder Code

47. Name

B. SALES BY OTHER THAN MOTOR VEHICLE DEALER

Gross Sales Price (Proof Required)

$ ______________________

6.25% Sales/Use Tax

$ ______________________

Insurance Certiication

The company signatory hereto hereby certiies that it has or will insure or guarantee performance by the applicant

hereinbefore named with respect to the motor vehicle hereinbefore described for a period at least coterminous with

C. CLAIM EXEMPTION FROM TAX CODE: __________________

that of such registration under a motor vehicle liability policy, binder or bond which conforms to the provisions of general laws, Chapter 175, Section 113A, and that the premium

charge and classiication on the effective date of registration are as established by the commissioner of insurance under Chapter 175, Section 113B, 113H and Chapter 175E.

Form Attached (if required)

49A. Policy Effective Date:

_____________________

Exempt Organization Certiicate #__________________________

49A. Policy Change Date:

_____________________

Fee Info.

49B. Manual Class:

49C. Ins. Company & Code:

57.

Reg:

$

___________________

Payment:

Insurance Co’s Authorized Representative’s Signature (Original Only)

Signatures

I/We the applicants hereby certify under the penalties of perjury that there are no outstanding excise tax liabilities on the vehicle

Title:

$

___________________

q Cash

described above that have been incurred by the applicant(s), any member of the applicant’s immediate family who is a member of

Tax:

$

___________________

q Check

the applicant’s household or the business partner of the applicant(s). I/We hereby further certify that all information contained in this application is true

and correct to the best of my knowledge and belief. I/We understand that false statements are punishable by ine, imprisonment or both.

P&I:

$

___________________

q EFT/ CC

50. Signature of Owner From Block 25 or 29. If owner is listed in Block 29, signer must also print name.

Total:

$

___________________

Clerk ID:

51. Signature of 2nd Owner From Block 27.

58.

Batch No:

52. Authorized Dealer’s Signature

53. Dealer Reg. No.

59.

Clerk/End User Initials:

54. Seller’s Name (Please Print)

55. Seller’s Address

Progressive Ins. form approved 1/2013

This form approved by the RMV 1/2013 www.massrmv.com

Owner

22. Owner 1 License # / ID # / or SSN

23. Owner 2 License # / ID # / or SSN

24. EIN/FID # (See block 29)

If Sole Proprietor

provide SSN in # 22

25. Owner # 1 Name (Last, First, Middle)

25a. Height

25b. Sex

26. Owner # 1 Date of Birth

_____ Ft _____ In

MALE

FEMALE

27. Owner # 2 Name (Last, First, Middle)

27a. Height

27b. Sex

28. Owner # 2 Date of Birth

_____ Ft _____ In

MALE

FEMALE

31. Mailing Address

City

State

Zip Code

32. Residential or Corp/Co/Organization Address (see block 24 and 29)

City

State

Zip Code

33A. Lessee’s MA License Number or EIN/FID Number. If out-of-state Lessee, use SSN and date of birth. 33B. Lessee’s Name:

M M D D

Y Y

34. Lessee’s Address, City, State, and Zip Code

Sales or Use Tax Schedule

56 A. SALE BY LICENSED MOTOR VEHICLE DEALER

Title

35. Date of Purchase

36. Odometer Reading

MA DOR-Registered Dealer EIN/FID # ______________________

Total Sale Price

$ ______________________

37. qNew Vehicle

38. Title Type: qClear

qSalvage

qReconstructed

(adjusted for dealer’s discount and manufacturer’s rebate)

qUsed Vehicle

qOwner Retained

qTheft

qPrior Owner Retained

Less Manufacturer’s Excise

$ ______________________

39. Primary Salvage Title Brands:

40. Secondary Salvage Brand(s)

qRepairable qParts Only

Net Sales Price

$ ______________________

Less Trade-in Allowance For:

$ ______________________

Yr __________

Make_____________

Model_______________

Trade-in VIN ___________________________________________

Taxable Sales Price

$ ______________________

6.25% Sales Tax

$ ______________________

B. SALES BY OTHER THAN MOTOR VEHICLE DEALER

Gross Sales Price (Proof Required)

$ ______________________

6.25% Sales/Use Tax

$ ______________________

Insurance Certiication

The company signatory hereto hereby certiies that it has or will insure or guarantee performance by the applicant

hereinbefore named with respect to the motor vehicle hereinbefore described for a period at least coterminous with

C. CLAIM EXEMPTION FROM TAX CODE: __________________

that of such registration under a motor vehicle liability policy, binder or bond which conforms to the provisions of general laws, Chapter 175, Section 113A, and that the premium

charge and classiication on the effective date of registration are as established by the commissioner of insurance under Chapter 175, Section 113B, 113H and Chapter 175E.

Form Attached (if required)

49A. Policy Effective Date:

_____________________

Exempt Organization Certiicate #__________________________

49A. Policy Change Date:

_____________________

Fee Info.

49B. Manual Class: 49C. Ins. Company & Code:

57.

Reg:

$

___________________

Payment:

Insurance Co’s Authorized Representative’s Signature (Original Only)

CERTIFICATE OF REGISTRATION

Title:

$

___________________

q Cash

Tax:

$

___________________

q Check

P&I:

$

___________________

q EFT/ CC

This document is the Certiicate of Registration for the herein

Total:

$

___________________

Clerk ID:

described vehicle. Section 11, Chap. 90, MGL states ...”Every

58.

Batch No:

person operating a motor vehicle shall have the Certiicate of

Registration for the vehicle and for the trailer, if any, and his

59.

Clerk/End User Initials:

license to operate, upon his person or in the vehicle in some

easily accessible place.”

Not Valid Until Stamped With Oficial Stamp or Registrar’s Signature

Progressive Ins. form approved 1/2013

This form approved by the RMV 1/2013 www.massrmv.com