HomeMy WebLinkAboutApplication for Duplicate Motor Vehicle Certificate of Title COUNTY OF HAWAII OFFICIAL USE ONLY
DEPARTMENT OF FINANCE
VEHICLE REGISTRATION&LICENSING DIVISION
101 PAUAHI STREET,SUITE NO.5
HILO,HI 96720 Number-Yearmlg'mal Issued
Application accepted and duplicate issued
Date Clerk
TYPEWRITE OR PRINT IN INK-Improperly filled application will not be accepted. 717'171
License Plate Nulnberi Makei �L{L{
Vehicle Identlflrotion Number: �noo
Registered Owner of Record:
Llenholdsrof Record:
Address
NUMBER AND STREET CITY ZIP CODE
The undersigned certifies that the Certificate of Title for the above described vehicle has been
stolen 0 lost F-1 mutilated F—]defaced,and hereby requests the issuance of a
duplicate.which Issuance shall void the original certificate.
SIGNATURE'S)OF LIENHOLOER OF RECORD
DEFACED OR MUTILATED []DRIVERS Llcs ❑DTHER
CERTIFICATE MUST BE EXPIRATION DATE EXPIRATION DATE
SURRENDERED WITH THIS
APPLICATION
SIGNATURE'S)OF LIENHOLDER OF RECORD
❑DRIVERS HraII ❑OTHER
EXPIRATION DATE EXPIRATION DATE
FOR OFFICE USE ONLY
DUPLICATE TITLE# SIGNATURE(S)OF LIENHOLDER OF RECORD
❑DRIVERS LlCII ❑OTHER
EXPIRATION DATE EXPIN-ON DATE
IF FIRM,ALSO PRINT NAME AND TITLE OF PERSON SIGNING.IF NO LIENHOLDER AND JOINT OWNERSHIP,ALL OWNERS MUST SIGN.
EFFECTIVE 011031]011,TO GENERATE A DUPLICATE CERTIFICATE OF TITLE,SIGNATURES MUST BE PROPERLY
NOTARIZED BELOW BY A NOTARY PUBLIC,OR VERIFIED ABOVE BY PRESENTING PROPER IDENTIFICATION FROM ALL
PARTIES AT THE VEHICLE REGISTRATION d LICENSING DIVISION.
STATE OF HAWAII NOTARY CERTIFICATION
(PLACE NOTARY SEAL HERE) (PLACE NOTARY SEAL HERE)
The foregoing Instrumen[was acknowledged before me Document Date q of pages
this dayof ,20 by Notary Name
and, Judicial Clreult
and Document D-erlption:
who Is/are personally known to n who has/have
produced the proper Identification as noted above.
Notary Public
Stale of Judicial Clrcuit
Notary Signature Date
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