West Virginia Owner and Purchasing Affidavit Form - Free Download
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West Virginia Owner and Purchasing Affidavit Form
West Virginia Owner and Purchasing Affidavit Form
MB-12/13
REV 02/12
West Virginia Department of Transportation
Division of Motor Vehicles
Owner and Purchasing Adavit
A) Owner/Sellers Information
B) Vehicle, Trailer, or ATV Information
C) Motorboat Information
Name: Daytime Phone:
Address:
STREET ADDRESS COUNTYCITY STATE ZIP
( )
D) Purchaser’s Information
Purchase Price: $ $ $ $ $ $
VEHICLE BOAT MOTOR TRAILER
TOTAL
ATV
IF SELLER IS NOT A WV RESIDENT, A DISCLAIMER FROM SELLER’S STATE DMV MUST BE ATTACHED
STATING THAT THERE IS NO PREVIOUS TITLE FOR THE VESSEL/VEHICLE.
Make:
VIN No.
Body Style:
Year
Make:
Length:
Model:
Year
Hull Serial Number
Motor Serial Number Motor Make: Hp
How, when and from whom was the above acquired
Name: Daytime Phone:
Address:
STREET ADDRESS COUNTYCITY STATE ZIP
( )
MORE INFORMATION IS ON THE BACK OF THIS FORM.
MAKE SURE ALL SECTIONS ARE COMPLETED AND SIGNED.
1-800-642-9066 • www.dmv.wv.gov
Receiving and Processing
PO Box 17710 • Charleston, WV 25317
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