Application for Michigan Vehicle Title

TRANSACTION TYPE PLATE EXPIRATION TITLE BRAND REG. FEE

YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER REC. PASSPORT FEE

BODY STYLE BASE MSRP EMPTY WEIGHT ODOMETER ODOMETER BRAND TITLE FEE

FIRST DRIVER'S LICENSE NO./ FEIN SECOND DRIVER'S LICENSE NO./ FEIN UNIQUE IDENTIFIER TITLE LATE FEE

NAME(S) AS IT WILL APPEAR ON CERTIFICATE OF TITLE AND REGISTRATION EXPEDITIOUS FEE

FULL RIGHTS TO SURVIVOR TAX

ADDRESS MAILING ADDRESS REG. TRANSFER FEE

TOTAL

FIRST SECURED PARTY FILING DATE SECOND SECURED PARTY FILING DATE

LIEN CODE ID LIEN CODE ID

APPLICANT IDENTIFICATION

Owner Other Name: ______ID presented: ______

CLAIM FOR TAX EXEMPTION USE TAX RETURN TYPE OF DOCUMENT REASON: 1. Purchase price or retail value, whichever is greater. COUNTY STATE 2. 6 ax I certify the tax exemption -percent t show above is valid. Initial box: 3. Credit for tax paid to a reciprocal state I certify I own this vehicle and all (proof attached) COURT FILE/ DOCKET # information on this application is correct to 4. Tax being paid the best of my knowledge.

New owner/applicant's signature PURCHASE DATE: SELLER'S NAME:

X

If you do not receive your new title within 60 days, please call the Department of State Information Center at 888-SOS-MICH (888-767-6424).

X This form or your title must be presented to purchase or transfer plates.

Final determination of the correct tax liability will be made by the Michigan Department of Treasury. You may be required to document your tax return or prove you are entitled to the exemption claimed. If you cannot support your claim, minimum penalties can be imposed including criminal prosecution or assessing up to 175 percent of the tax due.

Exemption - Transfer Between Relatives: An exemption from use tax is allowed when the new owner is the spouse, father, mother, brother, sister, child, stepparent, stepchild, stepbrother, stepsister, half-brother, half-sister, grandparent, grandchild, father-in-law, mother-in-law, brother-in-law, sister-in-law, son-in-law, daughter-in-law, grandparent-in-law, legal ward, or legally-appointed guardian of the previous owner. Documentation proving the relationship may be requested by the Michigan Department of Treasury.

VALIDATION:

JOCELYN BENSON, Secretary of State Authority granted under Public Act 300 of 1949 as amended. TR-11L (03/21 )