Free Statment of Intent - Wisconsin


File Size: 18.5 kB
Pages: 1
Date: January 25, 2005
File Format: PDF
State: Wisconsin
Category: Government
Author: DOTMZR
Word Count: 178 Words, 1,091 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.dot.wisconsin.gov/drivers/forms/mv2489.pdf

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STATEMENT OF INTENT
Clear Form
MV2489 10/2000

Wisconsin Department of Transportation

Person Making Statement

Vehicle Year

Make

Address

Vehicle Identification Number

Any person who knowingly makes a false statement in an application for a certificate of title may be fined not more than $5,000 or imprisoned not more than 7 years and 6 months or both s.342.06(2) Wis. Stats.

____ My name appears in error on the title of the vehicle described. I did not purchase the vehicle and have no interest in it.

____ As seller, I signed/printed my name in the purchaser area of the title by mistake. I do not wish to be a co-owner of the vehicle.

____ As seller, I signed/printed my name in the lien area of the title by mistake. I do not wish to be a lienholder of the vehicle.

____ As seller, I printed the wrong name in the purchaser area. The vehicle was actually sold to:________________________________________.

____ Other (describe in detail):

(Signature of Person Certifying)

(Date)

The Wisconsin Department of Transportation complies with the Americans with Disabilities Act.