APPLICATION FOR CERTIFICATE OF TITLE
(Type or Print in ink)
Fee of $5.00 for failure to apply for title within 30 days of assignment.
Motor Vehicle
Memorandum
Check type of application(s):
Watercraft
Duplicate
Outboard Motor
Replacement
Salvage
Lien
Certificate of Title Number: _____________________________________________________ Control Number:_____________________________
Applicant’s Printed Name: _____________________________________________________ SSN:________________________________________
Applicant’s Address: _________________________________________________________ Zip:_________________________________________
Lawful owner
Purchase
Lienholder
EVIDENCE OF OWNERSHIP: ________________________________________________________
MCO, MSO, Previous Title No., Registration, etc.
Applicant acquired said motor vehicle by: Purchased
From:
Repo
Auction
Other
Name of previous owner:__________________________________________________________________________
Address of previous owner:________________________________________________________________________
The following is a full statement of all liens on said motor vehicle. If no lien, state “none”. If more than one lien, attach statement of all additional liens.
Lienholder: _____________________________________________ Address: __________________________________________________________
Dealer’s Permit Number: ___________________________________ Vendor’s Number: __________________________________________________
Tax Exempt
Reason:_________________________________________________________________________________________________
Purchase Price $_______________________ Trade in Amount $_______________________ Sales/Use Tax $_______________________
Condition of Vehicle/Watercraft/Outboard Motor (check one only)
Good
Fair
Poor
Wrecked
Sales Credit Amount $______________________
YEAR______________ MAKE_____________________________________ MODEL___________________________________________________
VIN_________________________________________ BODY TYPE________________________ CONVERSION____________________________
ODOMETER CERTIFICATION
Federal and State laws require that you state the mileage in connection with transfer of ownership. Failure to complete or providing false information may result
in fines and/or in imprisonment.
, . 

(No Tenths) ACTUAL MILES
I (we) certify to the best of my (our) knowledge that the odometer now reads and is the actual mileage of the vehicle unless one of the following statement is checked:
Excess of Mechanical Limits
Not Actual – Odometer Discrepancy
Buyer’s Signature:_______________________________________________ Address:_____________________________________________________
Seller’s Signature:_______________________________________________ Address:_____________________________________________________
WATERCRAFT________________________________________________ Serial Number/HIN____________________________________________
YEAR_________________ MODEL______________________ LENGTH: __________feet __________ inches
MOTOR_______________ MOTOR SERIAL NUMBER_____________________________________________ HP:___________________________
Warning to transferor and transferee (seller and buyer) You are required by law to state the true selling price.
A false statement is in violation of section 2921.12 of the Ohio Revised Code and is punishable by six months
imprisonment and a fine of up to one thousand dollars or both. All transfers are audited by the Department of
Taxation. The seller and buyer must provide any information requested by the Department of Taxation. The
buyer may be assessed any additional tax found to be due.
State of Ohio :
County of Butler:
SS
Applicant’s Signature:_____________________________________________________________________
Sworn to and subscribed in my presence this___________ day of______________________ , 20_________
Clerk, Deputy Clerk of Court – Notary _____________________________