Ti 021A Form – Fill Out and Use This PDF

MAIL COMPLETED FORM TO: SOUTH CAROLINA DEPARTMENT OF MOTOR VEHICLES, P.O. BOX 1498, BLYTHEWOOD, S.C. 29016-0039.

SECTION 1 – VEHICLE INFORMATION Please print or type in black ink only.

VEHICLE IDENTIFICATION NUMBER

MAKE

YEAR MAKE

SECTION 2 – ODOMETER MILEAGE Miles not kilometers.

FEDERAL AND STATE LAW REQUIRES THAT YOU STATE THE MILEAGE IN CONNECTION WITH THE TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.

I STATE THAT THE ODOMETER NOW READS ______________________ (NO TENTHS) AND TO THE BEST OF MY KNOWLEDGE

THAT IT REFLECTS THE ACTUAL MILEAGE OF THE ______________________ VEHICLE DESCRIBED ABOVE UNLESS ONE OF THE

FOLLOWING STATEMENTS IS CHECKED:

DO NOT CHECK ONE OF THE FOLLOWING UNLESS IT APPLIES.

EXEMPT

I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS MECHANICAL LIMITS.

I CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE. WARNING ODOMETER DISCREPANCY.

SECTION 3 – OWNER INFORMATION Your complete legal name must be used on all title and registration documents.

NEW PRIMARY OWNER COMPLETE LEGAL NAME (LAST, FIRST, MIDDLE)

SC CUSTOMER NO., DRIVER LICENSE NO., SOC. SEC., OR FEIN	DATE OF BIRTH
NEW CO-OWNER COMPLETE LEGAL NAME (LAST, FIRST, MIDDLE)	SHARED OWNERSHIP
	AND OR
SC CUSTOMER NO., DRIVER LICENSE NO., SOC. SEC., OR FEIN	DATE OF BIRTH
PRIMARY OWNER’S RESIDENCE STREET ADDRESS (APT. NO. IF APPLICABLE)

MAILING ADDRESS (IF DIFFERENT FROM ABOVE)

SECTION 4 – FACTS AND INDEMNIFICATION AGREEMENT

PURCHASE PRICE

DATE OF PURCHASE

Explain why previous certificate of title was not obtained. Explain in detail how, where, and when you acquired the vehicle, who was involved, the condition of the vehicle, and any other information regarding the vehicle.

Warning: Fraudulent application and falsification of documents is a felony under South Carolina law. Under penalties of perjury, I declare that to the best of my knowledge and belief, this statement is true, correct, and complete. I further state that to the best of my knowledge, the vehicle is free and clear of any liens, encumbrances, lawful claims, demands of any person, and is not involved in any existing or pending litigation. I agree to indemnify the South Carolina Department of Motor Vehicles and all persons acting under direction of the Department, from any and all liability and shall defend all litigation that may arise as a result of the issuance of a South Carolina certificate of title in my name.

Signature of Applicant(s) All listed owners must sign.							Date
				FOR DEPARTMENT USE ONLY
	NCIC Check	No Hit Found		Hit Found
	CSR						Date
	NMVTIS Check	No Record Found		Theft Information
		Brands Listed		Odometer Listed
	CSR						Date

Obtaining a SC Title without a Previous Title

In order to receive approval to title a vehicle, trailer or mobile home where no previous title is available, the current owner of the vehicle, trailer or mobile home must submit the following:

 Affidavit of Ownership, Form TI-021A, to include the vehicle and current owner information, and a statement indicating how the vehicle was acquired to include in detail how, where and when the owner acquired the vehicle, who were the seller(s) and/or lien holder(s), the condition of the vehicle and any other information regarding the vehicle.

 Photographs of the vehicle from all angles (photos will not be returned).

 Vehicle Identification Verification for Title without Previous Title, Form TI-021B from a SCDMV official. The vehicle must be taken to a local DMV branch by the customer for an inspection if the customer wishes to obtain a South Carolina title.

If the Vehicle Identification Verification for Title without Previous Title indicates that the vehicle is not operable, the vehicle will be branded “Not for Road Use”.

In order to remove the ‘Not for Road Use” brand, the vehicle will have to be re- inspected with an indication to remove the “Not for Road Use” brand.

If a unique identifying number is not affixed to the vehicle, before proceeding with this request, the customer will be required to apply for an assigned serial number from the Department by completing Form 401-A.

 Copy of the owner’s South Carolina credential; or copy of the owner’s out of state credential, passport, employment authorization document or permanent residency card along with a completed Form TI-006.

 Additional Requirements for Mobile Homes

 A letter or receipt from the county treasurer’s office indicating property taxes are

current for the mobile home.

 Seven (7) years of property tax statements in the current owner’s name; or,

 Insurance company records indicating the home has been insured in the owner’s name for the previous 7 years or more.

 The insurance documents or property tax statements may also be used to indicate ownership rights of prior owners or the person(s) selling the vehicle, as well as former deeds or installment sales contracts or bills of sale identifying the mobile home by make, model year and VIN.