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County

District Court
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Plaintiff

vs.

Notice of Motion, Motion and Affidavit for Order Directing Issuance of Title to a Motor Vehicle (Minn. Stat. §§ 168A.04, 168A.08 168A.25)

Defendant (seller of vehicle)

Commissioner of Public Safety
Defendant

NOTICE OF MOTION AND MOTION To: The Above-named Defendant: and The Commissioner of the Department of Public Safety C/O Attorney Generals Office, Public Safety Division 445 Minnesota Street, Suite 1800 St. Paul, MN 55101-2134

TAKE NOTICE that on
Date

, at
(Time)

.m. at
(Location)

before the Honorable I will move the Court for the following order: That the Department of Public Safety, Division of Motor Vehicle Registration, shall issue a title and registration for the vehicle mentioned below, License Plate No. Vehicle Identification Number to State of Minnesota County of ) ) ss. ) AFFIDAVIT I
(first, middle, last)

,

, .

, being sworn/affirmed on oath state: .

1. I am the Plaintiff in this action. My date of birth is: 2. I purchased the vehicle described below from
MOV102 State ENG Rev 5/04 www.courts.state.mn.us/forms

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Name and Address of seller

for $ Make License Plate No. Vehicle Body Type Odometer

on
Date

. Model Year

Vehicle Identification No. New Used

This is the true cumulative mileage. It is unknown whether this is the true cumulative mileage. To the best of buyer(s) knowledge this vehicle has sustained damage in excess of 70% actual cash value has not sustained damage in excess of 70% actual cash value. 3. I am the sole owner of this vehicle. The following individual(s) is/are co-owner(s) of the vehicle: Provide first, middle, last name; address; and date of birth of each co-owner:

4. I paid in full the above amount and there is: no other secured interest in the vehicle. or the secured party Release.

has issued a Notice of

In order of priority, list Name, Address and Dates of security agreements of any secured parties: _________________________________________________________________________________ _________________________________________________________________________________

5. I have been unable to obtain a certificate of title from the former owner for the following reason(s): I have been unable to locate the former owner to obtain the Certificate of Title for the vehicle. Other (specify)

6.

The reason given by the Department of Public Safety for not issuing a title is: the Department has reasonable grounds to believe that I am not the owner of the vehicle;

MOV102

State

ENG

Rev 5/04

www.courts.state.mn.us/forms

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the Department has reasonable grounds to believe that the application contains a false or fraudulent statement; I have failed to furnish required information or documents or any additional information the Department reasonably requires; I have not paid at least one month's registration tax or registered the vehicle under MS. 168.187. 7. I was told that I could obtain a title for the vehicle only if I posted a bond in the amount of $______________. I have posted the bond. I have not posted the bond.

Dated:
Signature (Sign only in front of notary public or court administrator.)

Name: Sworn/affirmed before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

See Next Page for Affidavit of Mailing

MOV102

State

ENG

Rev 5/04

www.courts.state.mn.us/forms

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STATE OF MINNESOTA ) ) ss. COUNTY OF )

Affidavit of Mailing

, being duly sworn/affirmed on oath, state that on , I served the Notice of Motion, Motion and Affidavit for Order Directing Issuance
(Date)

of Title to a Motor Vehicle on
(Defendant's name)

by placing a true and correct copy thereof in an envelope addressed to him/her at their last known address and depositing the same, with postage prepaid, in the United at:
( address, city, state)

States Mail at

, Minnesota.

Affidavit of Mailing
, being duly sworn/affirmed on oath, state that on , I served the Notice of Motion, Motion and Affidavit for Order Directing Issuance
(Date)

of Title to a Motor Vehicle on Commissioner of Public Safety by placing a true and correct copy thereof in an envelope addressed to: The Commissioner of Public Safety, C/O Attorney Generals Office, Public Safety Division, 445 Minnesota Street, Suite 1800, St. Paul, MN 55101-2134 and depositing the same, with postage prepaid, in the United States Mail at , Minnesota.

Dated:
Signature (Sign only in front of notary public or court administrator.)

Name: Sworn/affirmed before me this day of , . Address: City/State/Zip: Telephone:
Notary Public \ Deputy Court Administrator

MOV102

State

ENG

Rev 5/04

www.courts.state.mn.us/forms

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