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Free Louisiana Vehicle Application Form

The Louisiana Vehicle Application form is a document required by the Louisiana Department of Public Safety and Corrections for registering vehicles in the state. This form gathers essential information about the vehicle and its owner, ensuring compliance with local regulations. To begin the registration process, fill out the form by clicking the button below.

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Structure

The Louisiana Vehicle Application form is a crucial document for individuals looking to register a vehicle in the state. This form gathers essential information regarding the vehicle, including details such as the Vehicle Identification Number (VIN), make, model, year, and body color. It also requires information about the owner, including their name, address, and driver's license number. If applicable, the form allows for the inclusion of a joint owner. Additionally, it addresses the residency status of the owner, asking whether they reside within municipal limits or special tax districts. For those purchasing a vehicle through a dealer, the dealer code must be included. The form also outlines necessary fees, such as license fees and taxes, which must be paid to avoid penalties. Notably, if the vehicle is subject to a security agreement, the names of the lienholders must be provided. For individuals applying for a duplicate title, a notarized affidavit is required, affirming the loss or non-receipt of the original title. Furthermore, proof of liability insurance is mandatory before the application can be processed. The form also encompasses sections for various declarations, including those related to farm use, out-of-state residency, and disclosures about salvage or damaged vehicles. Completing this form accurately is essential to ensure a smooth registration process and avoid any potential delays or rejections.

Sample - Louisiana Vehicle Application Form

Louisiana Department of Public Safety and Corrections

TO AVOID REJECTION:

Office of Motor Vehicles

Complete all required information

P.O. Box 64886, Baton Rouge, LA 70896-4886

TRANSFER CODE

ELECTRONIC FUND

Date Prepared

Type of Plate

VEHICLE APPLICATION

DEALER CODE

VIN

Make

License No.

Exp. Date

Body

Color

Year

Mileage

Model/Weight

Name of Owner

Driver's License or EIN

Name of Joint Owner (if applicable)

Driver's License or EIN

Owner's Principal Residence Address (or Business Location if Vehicle is Used for Commercial Purposes)

Are you

residing within the corporate limits of municipality?

YES

City

Parish

State/Zip

Are you residing within a special tax district or ward?

YES

If yes, what ward or district?

Lessee

Mail To

Domicile

Renter

If lessee, domicile, or renter is indicated, renewal notice

should be mailed to (check one):

Domicile Code

Owner

Lessee, renter, or domicile address

Name

Driver's License or EIN of Lessee or Renter

Street

Trade VIN

City

Parish

State/Zip

Trade License No.

VEHICLE IS SUBJECT TO SECURITY AGREEMENT AS FOLLOWS:

ELECTRONIC LIEN

First Lienholder's Name

Second Lienholder's Name

TRANSFER CODE

Street

City/State/Zip

New

Date Acquired

Tax Date

Previous Title No.

State

Cost of Vehicle

Less Trade

Used

Title Fee

Lic Pen Credit

Handling Fee

Rebate

Tax Value

Mortgage Fee

Tax

Tow Fee

DUPLICATE TITLE AFFIDAVIT (Must be signed by owner and notarized.)

The certificate of title issued to me was

License Fee

*Tax Penalty

Miscellaneous Fee

. lost

mutilated

never received

Lic Transfer Fee

*Interest

Total Fees

I make application for a duplicate copy of said certificate and agree to hold the

License Credit

Vendor's Comp

Total Taxes

Commissioner harmless if the previous title is obtained by another person.

I give the Commissioner permission to mail the title to the address on this

License Penalty

Tax Credit

Grand Total

application.

BE SURE TO SIGN AND DATE

I do swear or affirm that the information contained in this document is true and

Owner(s)'s Signature(s) for Duplicate Title

correct to the best of my knowledge.

I have and will maintain, during this registration period, vehicle liability insurance

Witness

(security) required by LRS Title 32:861-865. Failure to maintain as agreed will

Sworn and subscribed before me this ________ day of ____________, _______

be a violation of law which may result in criminal prosecution and/or suspension

of registration privileges.

Notary Public Signature, Printed Name

ID Number

If the vehicle being registered is defined as a commercial motor vehicle by the

AFFIDAVIT OF NON-POSSESSION OF TITLE BY LIENHOLDER.

Federal Motor Carrier Safety Regulations and/or Federal Hazardous Material

Regulations, by signature below registrant declares knowledge of those federal

Must be signed by lienholder and notarized.

regulations.

I hereby swear or affirm that title of above described vehicle showing lien in our

favor was

never received

received and surrendered to the owner.

Applicant's Signature

Date

Co-Applicant's Signature

Date

Lienholder's Signature

PROOF OF LIABILITY INSURANCE MUST BE FURNISHED AS

PROVIDED FOR BY LAW BEFORE THIS FILE CAN BE PROCESSED.

Witness

TO AVOID PENALTY AND INTEREST:

Sworn and subscribed before me this ________ day of ____________, _______

File must be submitted within 40 days from the date of purchase. For

manufactured houses (mobile homes), file must be submitted by the 20th of the

month following the month of delivery.

Notary Public Signature, Printed Name

ID Number

*Tax Penalty: 5% of sales tax due for 30 days or fraction thereof (not to

RECEIVED/REJECTION DATE(S)

exceed 25%).

*Interest: 1.25% of sales tax due for 30 days or fraction thereof

(no maximum).

NOTICE:

If a title, license plate, or validation sticker is not received within thirty (30) days after submitting application and fees for such, contact your nearest Office of Motor Vehicles. Departmental policy provides for the issuance of a free replacement within sixty (60) days from the date of issuance. Failure to notify this office timely could result in additional fees being charged.

A.	CONVERSION
	Old License Plate Number _____________________	New License Plate Number _____________________
	Use _____________________	Use _____________________
	Weight _____________________	Weight _____________________

B.TRANSFER OF PLATE

License plate ___________________ has been removed from a _______________________________________________________

YEAR MAKE VIN

and transferred to the vehicle described on the first page of this form. License plate returned is ______________________________

C. LOST, STOLEN, OR REPLACEMENT

PLATE

STICKER

License Plate Number ________________

D.TITLE CORRECTION

Error: _____________________________________________________________________________________________________

__________________________________________________________________________________________________________

Correct To: ________________________________________________________________________________________________

__________________________________________________________________________________________________________

E.FARM USE STATEMENT

I do declare that I am a bona fide farmer and am in the business of farming; that the vehicle described on the first page of this form is used primarily, but not exclusively, in hauling farm produce raised on my farm, from such farm to market and return therefrom; hauling merchandise to my farm and that this vehicle will not be used to haul another person's farm produce or other products for a fee or compensation. Said farm is located at:

________________________________________________________________________________________________________________

RFDBoxCityParishZip

________________________________________________________________________________________________________________

Owner's Signature

F.OUT OF STATE DECLARATION


I,		declare that the
	(Printed name of owner)		MAKE	MODEL	VIN
was domiciled in Louisiana on			.

G.DISCLOSURE OF SALVAGE / RECONSTRUCTED / WATER DAMAGED / HAIL-DAMAGED

I,	swear under penalties of perjury that:

(Printed name of owner)

the title covering the vehicle,

MAKEMODEL

Louisiana R.S. 32:706.1, has been branded:

VIN

Salvaged Vehicle

,in accordance with

Reconstructed Vehicle

In accordance with Louisiana R.S. 32:789, the undersigned confirm that the above referenced vehicle has sustained water damage to the following extent:

In accordance with Louisiana R.S. 32:781, the undersigned confirm that the above referenced vehicle has sustained water damage

to the following components: Power Train

Computer

Electrical System

In accordance with Louisiana R.S. 32:702(13), the undersigned confirm that the above referenced vehicle has sustained only cosmetic damage caused by hail, equivalent to seventy-five percent or more of its market value as a result of costs or repairs to items such as windshield, windows, and rear glass; exterior paint and paint materials; and body damage such as dents.

Hail-Damaged

Signed by

under penalties of perjury this day of

(Signature of vehicle owner)

, 20

False statements are punishable by fine, imprisonment or both under R.S. 32:730.

↓ Louisiana Vehicle Application File

Form Characteristics

Fact Name	Details
Governing Law	The Louisiana Vehicle Application form is governed by Louisiana Revised Statutes Title 32:861-865.
Required Information	Applicants must complete all required fields to avoid rejection of their application.
Submission Deadline	Applications must be submitted within 40 days from the date of vehicle purchase to avoid penalties.
Proof of Insurance	Proof of liability insurance is mandatory before the application can be processed.
Duplicate Title Affidavit	If the title is lost or mutilated, a duplicate title affidavit must be signed and notarized by the owner.
Special Designations	The form includes sections for commercial vehicles and farm use declarations, which have specific requirements.

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