Application for Michigan Vehicle Title
USE TAX RETURN
TRANSACTION TYPE PLATE EXPIRATION TITLE BRAND
YEAR MAKE
MODEL
VEHICLE IDENTIFICATION NUMBER
REG. FEE
REC. PASSPORT FEE
TITLE FEE
TITLE LATE FEE
EXPEDITIOUS FEE
TAX
REG. TRANSFER FEE
TOTAL
BODY STYLE
FIRST DRIVER LICENSE NO./ FEIN SECOND DRIVER LICENSE NO./ FEIN
BASE MSRP
EMPTY WEIGHT ODOMETER ODOMETER BRAND
UNIQUE IDENTIFIER
NAME(S) AS IT WILL APPEAR ON CERTIFICATE OF TITLE AND REGISTRATION
ADDRESS MAILING ADDRESS
FULL RIGHTS TO SURVIVOR
FILING DATE FILING DATEFIRST SECURED PARTY
SECOND SECURED PARTY
CLAIM FOR TAX EXEMPTION
REASON:
PURCHASE DATE:
New owner/applicant's signature
X
X
I certify I own this vehicle and all
information on this application is correct to
the best of my knowledge.
If you do not receive your new title within 60 days, please call the
Department of State Information Center at 888-SOS-MICH (767-6424).
This form or your title must be presented to purchase or transfer plates.
1. Purchase price or retail value,
whichever is greater.
2. 6-percent tax
3. Credit for tax paid to a reciprocal state
(proof attached)
4. Tax being paid
Other ID presented: ___________________________________________
APPLICANT IDENTIFICATION
Owner Name: _________________________
TYPE OF DOCUMENT
COUNTY
COURT
STATE
FILE/ DOCKET #
I certify the tax exemption
show above is valid. Initial box:
SELLER'S NAME:
Final determination of the correct tax liability will be made by the Michigan Department of Treasury. You may be required to document your tax return or
prove you are entitled to the exemption claimed. If you cannot support your claim, minimum penalties can be imposed including criminal prosecution or
assessing up to 175 percent of the tax due.
Exemption - Transfer Between Relatives: An exemption from use tax is allowed when the new owner is the spouse, father, mother, brother, sister, child,
stepparent, stepchild, stepbrother, stepsister, half-brother, half-sister, grandparent, grandchild, father-in-law, mother-in-law, brother-in-law, sister-in-law,
son-in-law, daughter-in-law, grandparent-in-law, legal ward, or legally-appointed guardian of the previous owner. Documentation proving the relationship
may be requested by the Michigan Department of Treasury.
VALIDATION:
JOCELYN BENSON, Secretary of State
Authority granted under Public Act 300 of 1949 as amended.
TR-11L (01/21)
LIEN CODE ID
LIEN CODE ID
