Fillable Printable Corrected Or Substitute Title Application
Fillable Printable Corrected Or Substitute Title Application
Corrected Or Substitute Title Application
MVR-5
(Rev. 05/17)
YEAR SERIES MODEL
TYPE OF FUEL
Owner 1 ID #
Owner 2 ID #
Tax County
Account # Account #
State State
Spelling of name incorrect Year model in error
Change of name (See notes A & B) Wrong lienholder (see note D)
Identification number (See note C) Change of motor or body (See note E)
Body style Title incorrectly assigned (See note F)
Joint applicants request this title to be issued with Joint Tenants with Rights of Survivorship
Date County State
purpose stated therein and in the capacity indicated: (name(s) of principal(s)).
Notary Signature
My Commission Expires
TITLE NUMBER
Notary Printed or Typed Name
City
Zip Code
Signature of owner(s)
Full Legal Name of Owner 1 (First, Middle, Last, Suffix) or Company Name
Full Legal Name of Owner 2 (First, Middle, Last, Suffix) or Company Name
ODOMETER READING
Lienholder ID#
Lienholder Name
Lienholder ID#
Lienholder Name
Date of Lien
Maturity Date
Date of Lien
Maturity Date
I certify for the motor vehicle described above that I have financial responsibility as required by law.
Plate Number
Zip Code
I, the undersigned, owner of the vehicle described above, hereby certify that the information contained herein is true and accurate to the best of my knowledge.
Address
Address
(seal)
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the
DISCLOSURE SECTION
All motor vehicle records maintained by the North Carolina Division of Motor Vehicles will remain closed for marketing and solicitation unless the block below is checked.
I (We) would like the personal information contained in this application to be available for disclosure.
CHECK REASON FOR CORRECTION OF TITLE
City
Mailing Address (if different from above)
Insurance company authorized in N.C.
Policy Number
Residence Address (Individual) Business Address (Firm)
City and State
Zip Code
VEHICLE IDENTIFICATION NUMBER
ODOMETER BRAND
ODOMETER READING
(See reverse side for lienor's confirmation, regulations and notes)
North Carolina Division of Motor Vehicles
Corrected or Substitute Title Application
VEHICLE SECTION
MAKE
BODY STYLE
OWNER SECTION
Give detailed explanation of alterations and changes:
LIEN SECTION
FIRST LIEN
SECOND LIEN
