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    Pa mv-1

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    Pa mv-1

    Uploaded by

    darnellis
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    pa mv-1

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    12 views1 page

    Pa mv-1

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    darnellis

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    © All Rights Reserved
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    MV-1L (12-16)

    APPLICATION FOR LESSEE INFORMATION


    www.dmv.pa.gov

    APPLICATION TO ADD, CHANGE OR DELETE LESSEE


    INFORMATION FOR A LEASED VEHICLE
    For Department Use Only
    Bureau of Motor Vehicles • PO Box 68593 • Harrisburg, PA 17106-8593

    CHECK (4) THE APPROPRIATE BLOCK:

    Daily Rental Vehicle - Complete Sections A, B and E.


    o
    Leased Vehicle - Check the appropriate box below and complete sections indicated:
    o
    o Add Lessee Information - Complete Sections A through E.
    o Change Lessee Information - Complete Sections A and C (if changed), D (if changed) and E.
    o Delete Lessee Information - Complete Sections A and E.
    NOTE: Any changes in this information provided at time of the original application will require a new MV-1L to be completed
    and returned to PennDOT (i.e., daily rental to long term lease, long term to daily rental).

    A VEHICLE INFORMATION
    Vehicle Identification Number Title Number Registration Plate Number

    B VEHICLE OWNER INFORMATION - NOTE: The title will always be in the name of the owner and mailed to the owner or encumbrance holder.
    Last Name or Full Business Name First Name Middle Name

    Street Address

    City County State Zip Code

    C LESSEE INFORMATION - Person/Company leasing the vehicle from the vehicle owner.
    Applicant Last Name or Full Business Name First Name Middle Name PA DL/Photo ID# Date of Birth
    or Bus ID#

    Co-Applicant Last Name First Name Middle Name PA DL/Photo ID# Date of Birth

    Current Street Address

    City County State Zip Code

    D MAILING INFORMATION - Please read each column heading.


    Check the appropriate Registration owner - keeps Registration document recipient - Application to renew recipient -
    block to indicate the registration plate when the receives the registration plate, receives the registration
    the proper combination lease expires. card, weight class decal, and VIN plate. renewal application.

    0 o Vehicle Owner Vehicle Owner Vehicle Owner

    1 o Vehicle Owner Lessee Vehicle Owner

    5 o Vehicle Owner Vehicle Owner Lessee

    6 o Lessee Lessee Vehicle Owner

    7 o Lessee Vehicle Owner Lessee

    2 o Lessee Lessee Lessee

    E CERTIFICATION
    I certify all information listed above is TRUE and CORRECT.

    Signature of Vehicle Owner or Authorized Person Date

    Visit us at www.dmv.pa.gov or call us at:


    In state: 1-800-932-4600 u TDD: 1-800-228-0676 u Out-of-State: 1-717-412-5300 u TDD Out-of-State: 1-717-412-5380

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