Free RD-108 Application for Michigan Title & Registration - Michigan


File Size: 223.0 kB
Pages: 1
File Format: PDF
State: Michigan
Category: Secretary of State
Author: Mary Raczok
Word Count: 593 Words, 4,641 Characters
Page Size: 624 x 849 pts
URL

http://www.michigan.gov/documents/rd-108notes01_19161_7.pdf

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82523

STATE OF MICHIGAN

APPLICATION FOR MICHIGAN TITLE & REGISTRATION STATEMENT OF VEHICLE SALE
______________
Invoice/Stock No.

DEPARTMENT OF STATE

Purchase Date_________________________ Delivery Date__________________________
Dealer

______________
Invoice/Stock No.

Expires On Month Day

Months Year

s NEW PLATE s RENEWAL s TRANSFER
Code County License Fee

Address

Year

Make

Body Style

City County State Zip Code

Vehicle No.

Fee Category/Weight

Driver License No./PIDs of All Owners or Lessees 1) 2) 3) County of Residence

Title

MICHIGAN
Dealer License Sales Tax License Phone Number

Title Late Fee

Vehicle Sold New
Trade-In Year

s

Used

s

Demo

s

Trade-In

Yes

s

No

s

Complete Names and Addresses of All Owners or Lessors

Tax

Make

Vehicle No.

Reg. Transfer Fee

Total - Transfer to #4 TEMPORARY VEHICLE REGISTRATION USED TO TRANSFER PLATES Expires 15 days after delivery date Plate transferred from: Year Make Complete Names and Addresses of All Lessees

Full Rights to Survivor Yes

Vehicle No.

Plate No.

Temp. Expiration Date Insurance Company Policy No. or Binder No.

s

No

s

VEHICLE USE AND HISTORY DISCLOSURE:

s POLICE VEHICLE s GOVERNMENT VEHICLE s TAXI

s VEHICLE HAS BEEN FLOOD-DAMAGED s SALVAGE TITLE HAS PREVIOUSLY BEEN ISSUED s __________________________________________
ODOMETER MILEAGE

First Secured Interest _____________________________________________________

Filing Date

Address _______________________________________________________________________ City-State Zip Second Secured Interest______________________________________________________ Filing Date

The following section must be completed when odometer disclosure is required. The odometer mileage reading must match the mileage reading disclosed to the purchaser on the title and/or mileage statement.

NO TENTHS

Address _______________________________________________________________________ City-State Zip

s actual mileage s not actual mileage s exceeds mechanical limits of odometer Factory Installed Accessories s Factory List Affixed To Vehicle

01. PURCHASE PRICE OF VEHICLE (Including Freight & Accessories) 02. OTHER TAXABLE CHARGES (Documentary Fee, Service Fee, Temp. Reg. Fee, Etc.) 03. TOTAL TAXABLE PRICE 04. (Above total) SALES TAX - LICENSE - TITLE

Dealer Installed Accessories When Optional to Purchaser

05. NON-TAXABLE CHARGES (Labor, Service Contract, Etc.) 06. TOTAL DELIVERED PRICE 07. CASH ON DEPOSIT 08. CASH DUE ON DELIVERY 09. TRADE-IN
$ $

REMARKS:

10. LESS LIEN 11. TOTAL DOWN PAYMENT 12. UNPAID BALANCE TO BE FINANCED 13. INSURANCE CHARGE*

14. TOTAL AMOUNT OF FINANCE CONTRACT
CONTRACTUAL DISCLOSURE STATEMENT FOR USED VEHICLES ONLY "The information you see on the window form for this vehicle is part of this contract. Information on the window form overrides any contrary provisions in the contract of sale." "I CERTIFY I SOLD THIS VEHICLE TO THE PURCHASER NAMED IN THIS FORM. I WARRANT THE TITLE TO THE VEHICLE AND CERTIFY THAT THE VEHICLE IS SUBJECT ONLY TO THE SECURITY INTERESTS NAMED ABOVE." *TYPE OF INSURANCE WARNING: This insurance is not PL/PD No Fault Insurance required by Michigan Law.

s s

CREDIT LIFE GAP INSURANCE

s s

HEALTH & ACCIDENT __________________________________

Temporary Temporary Registration No.______________________________________ Fee Charged Yes Dealer's Signature Title

s

No

s

Salesperson ____________________________________________________________________

PURCHASER WARNING: DO NOT SIGN BLANK FORM
I am purchasing or leasing this vehicle and am applying for a Michigan certificate of title and registration or, if the lessee, applying for a registration. I certify my driver license is not suspended, revoked, or denied as a repeat offender and I am eligible to purchase or register this vehicle. I further certify that if a tax exemption is shown above it is valid. X ___________ ______________________________________________________________
Date Date Date

X ___________ _______________________________________________________________
Date Date Date

X ___________ ______________________________________________________________ X ___________ ______________________________________________________________
Purchaser's/Lessor's Signature(s)

X ___________ _______________________________________________________________ X ___________ _______________________________________________________________
Lessee's Signature(s)

PURCHASERS NOTE: IF VEHICLE TITLE IS NOT RECEIVED WITHIN 30 DAYS, CONTACT THE BUREAU OF REGULATORY SERVICES AT 1-800-292-4204
Authority granted by P.A. 300 of 1949, as amended.

THIS FORM MUST BE TYPED ONLY

RD-108 12/02