Title Release Form
Vehicle Identification Number
Vehicle
Year
Make
Model
Owner Name
First Name
Middle Name
Last Name
Driver's Licence Number
Email
example@example.com
Phone Number
Please enter a valid phone number.
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does mailing address same with physical address?
Yes
No
Physical Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
The immediate need for the title is due to
Dealer's Business Name
Business License Number
Authorized Representative Name
First Name
Last Name
Dealer’s Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I, the undersigned, agree with the following statements:
I am the legal owner of the vehicle described above and I am unable to go to a Department of Motor Vehicles office to apply for the Certificate of Title because of the reasons described above.
I understand it is a gross misdemeanor to use a false or fictitious name oraddress in this authorization letter, or to knowingly make a false statement or knowingly conceal amaterial fact or otherwise commit a fraud in this application.
I hereby authorize the Department of Motor Vehicles to release the new Nevada title to the abovelicensed dealer. I declare under penalty of perjury that the foregoing is true and correct.
Date
-
Month
-
Day
Year
Date
Signature
Submit
Should be Empty: