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This page is used to apply for a New York State Title for vehicles that are transferred to lenders at the conclusion of an open end finance agreement. The information is populated on the most current motor vehicle forms and submitted to the DMV for processing upon receipt of the Title document. The form will prompt you to indicate the state the vehicle was last Titled, the anticipated mailing date of the document, and the type of courier used.


Lienholder Information
Name  
Address  
Zip Code  
City  
State  
County  

Vehicle Description
VIN  
Year  
Make  
Body Type  
Doors  
Type of Power  
Cylinders  
Unladen Weight  
Color  
Odometer Reading
(in miles)
 
Mileage Brand
Vehicle's ODOMETER
has room for how many numbers?
 
For Other Vehicles  
For trailers and commercial vehicles
MAX Gross Weight

Seller's Information
Name  
Address  
Zip Code  
City  
State  
County  



Lessor Name    
Lessor's Certificate of Authority number is    
 
DAMAGE DISCLOSURE STATEMENT
I certify that, to the best of my knowledge, this vehicle:

wrecked, destroyed or damaged to such an extent that the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of the loss. (Checking the "has been" box means the vehicle must have an anti-theft examination before being registered, and that the title issued will have the statement "Rebuilt Salvage: NY" on it.)

 

 

 

 

Reference Number
Name of person submitting form  
Daytime Phone  
Email Address    

THIS TRANSACTION OR SERVICE IS ALSO AVAILABLE, AT NO CHARGE, DIRECTLY FROM THE OFFICIAL DEPARTMENT OF MOTOR VEHICLES WEBSITE AT WWW.NYSDMV.COM