Request for title or registration correction



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Date12.05.2016
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THIRD PARTY REQUEST FOR TITLE OR REGISTRATION CORRECTION

Wisconsin Department of Transportation (WisDOT)



MV1047 5/2015 S. 341.21 Wis. Stats.



Vehicle Identification Number (VIN) (standard VIN has 17 characters)

License Plate Number

Title Number


                                 


               


                         



Model Year

Make


    

     




Terminal ID/ Dealer Number

Agent’s Legal Business Name

(Area Code) Telephone Number

Contact Person


             

     

     

     



Describe in detail the change you are requesting






And/Or Conjunction (Send current title and all customer signatures)







     






Owner (Changes of ownership may require a completed MV1, MV11 or MV12, the original title and titling fees)







     






Lien (Send current title, lien release, loan filing fee) (Owner and lender cannot be the same)







     






Plates/Registration







     






Other (mileage, color, lessee, etc.) Please provide explanation.







     


NOTE: For Odometer corrections this form must be submitted along with the secured MV11 or MV2488 forms.


Please contact the Agent Partnership Unit with questions.




I agree to protect and indemnify the Wisconsin Department of Transportation in any claims arising out
of the issuance of a changed title or registration on the above-described vehicle. I also certify with my signature that to the best of my knowledge the information and statements on this request for changes are true and correct.



X




     

(Signature)




(Date – m/d/yyyy)


Please send completed form to:

Wisconsin Department of Transportation

Agent Partnership Unit

PO Box 7909



Madison, WI 53707-7909


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