APPLICATION FOR DUPLICATE
CERTIFICATE TO TITLE
Fee $9.00
State Statute
31-2-105

To the County clerk of ______________________________________, County, Wyoming:

I hereby make application for a duplicate Wyoming Certificate of Title for the following motor vehicle, trailer or mobile home, as described below:

TITLE NUMBER____________________________                VIN__________________________     MAKE_____________________________________            YEAR________________________

To the best of my knowledge and belief there are no liens against the vehicle except those liens shown on the original title.  The original title is (Check One)

            LOST (      )                       MUTILATED (      )                 DESTROYED (      )

Furthermore, the title has not been assigned to any other person, nor is it in the possession of any other person.

NAME                  _______________________________________

ADDRESS            _______________________________________
                                       (Where Duplicate title is to be mailed)
                        _______________________________________

I hereby swear or affirm under penalty that all the information on this application for Certificate of title is true and correct and that I am lawfully applying for a Wyoming Certificate of Title.

Signature of Applicant ______________________________________________

Subscribed and sworn to before me this ________________ day of _______________________.
(Year) _________________________.
                                                                                   _____________________________
                                                                                   Notary Public or Deputy County Clerk
My Commission Expires _______________
Date Received _________________________          Date Title Can Be Made _______________
Date Title Made ________________________

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