Form BMV3772 "Application for Dealer Assignment" - Ohio

What Is Form BMV3772?

This is a legal form that was released by the Ohio Department of Public Safety - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2021;
  • The latest edition provided by the Ohio Department of Public Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form BMV3772 by clicking the link below or browse more documents and templates provided by the Ohio Department of Public Safety.

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Download Form BMV3772 "Application for Dealer Assignment" - Ohio

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OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
APPLICATION FOR DEALER ASSIGNMENT
POWER OF ATTORNEY TO TRANSFER OWNERSHIP AND ATTESTATION OF MILEAGE AND IDENTITY FOR THE TRANSFER OF OWNERSHIP OF
A VEHICLE OR WATERCRAFT TO OR FROM A MOTOR VEHICLE OR WATERCRAFT DEALER LICENSED BY CHAPTERS 4517/1547 PURSUANT
TO OHIO REVISED CODE 4505.032/1548.032 AND APPLICATION FOR CERTIFICATE OF TITLE.
ASSIGNMENT OF OWNERSHIP
I (we) certify the vehicle or watercraft or outboard motor described in this statement was delivered on
for the price of $
Is Seller a Minor?
Yes
No
to:
TRANSFEREE’S / BUYER’S PRINTED NAME
TRANSFEREE’S / BUYER’S PRINTED ADDRESS
Warning to transferor and transferee (seller and buyer). You are required by law to state the true selling price. A false statement is in violation of section
2921.13 of the Ohio Revised Code and is punishable by six months imprisonment and a fine of up to one thousand dollars or both. All transfers are audited
by the Department of Taxation. The seller and buyer must provide any information requested by the Department of Taxation. The buyer may be assessed
any additional tax found to be due.
PICTURE ID ISSUED FROM STATE OF
OPERATOR LICENSE NUMBER OR ID NUMBER
CURRENT TITLED OWNER(S) NAME
CONTROL NUMBER
YEAR
MAKE
MODEL
BODY TYPE
LENGTH
TITLE NUMBER
HP
CURRENT TITLE TYPE
THIS VEHICLE WAS A (IF APPLICABLE)
REGULAR
FORMER LAW ENFORCEMENT
SALVAGE
FORMER TAXI
VIN/WIN/MIN
OFF ROAD
FLOOD VEHICLE
Federal and State laws require that you state the mileage in connection with transfer of ownership. Failure to complete or providing false information may
result in fines and/or imprisonment.
,
I (we) certify to the best of my (our) knowledge that the odometer now reads
NO TENTHS MILES
and is the actual mileage of the vehicle unless one of the following statements is checked.
The mileage stated is in excess of the mechanical limits.
The odometer reading is not the actual mileage.
WARNING–ODOMETER DISCREPANCY
APPLICATION FOR CERTIFICATE OF TITLE (Type or Print in Ink) Fee of $5.00 for failure to apply for title within 30 days of assignment.
CHECK TYPE OF APPLICATION(S):
MOTOR VEHICLE
MEMORANDUM
WATERCRAFT
DUPLICATE (Check One)
OUTBOARD MOTOR
SALVAGE
REPLACEMENT
Lost
Stolen
Destroyed
APPLICANT’S PRINTED NAME
SSN/EIN
APPLICANT’S PRINTED STREET ADDRESS
CITY
STATE
ZIP CODE
COUNTY
VENDOR’S DISCOUNT
PURCHASE PRICE
TRADE IN ALLOWANCE
GROSS TAX DUE
$
$
$
$
DEALER’S PERMIT NUMBER
TAX PAID
TAX EXEMPTION:
YES
$
REASON
VENDOR’S NUMBER
CONDITION OF VEHICLE OR WATERCRAFT OR OUTBOARD MOTOR (CHECK ONLY ONE):
GOOD
FAIR
POOR
WRECKED
LIEN INFORMATION: If no lien, state “none”. If more than one lien, attach statement of all additional liens.
LIENHOLDER PRINTED NAME/E CODE #
ADDRESS
CITY
STATE
ZIP CODE
I (we) state that all information contained in this application is true and correct.
IS APPLICANT A MINOR?
YES
NO
APPLICANT’S SIGNATURE
PRINTED
NON PRINTED
X
TRANSFEREE’S / BUYER’S ACKNOWLEDGEMENT OF ABOVE ODOMETER CERTIFICATION AND/OR DUPLICATE TRANSACTIONS
TRANSFEREE’S / BUYER’S OR APPLICANT’S PRINTED NAME
TRANSFEREE’S / BUYER’S SIGNATURE
X
I/We, the current titled owner or applicant, appoint
as my true and lawful attorney-in-fact to execute any
and all application for assignment of Certificate of Title for the motor vehicle listed above. I attest to the above odometer reading.
I warrant the title to be free of all liens.
TRANSFEROR’S / SELLER’S PRINTED NAME
TRANSFEROR’S / SELLER’S SIGNATURE
X
TRANSFEROR’S / SELLER’S PRINTED ADDRESS
CITY
STATE
ZIP CODE
NOTE: All blank spaces above must be completed before acknowledgement. If not applicable, insert NA or NONE in the space provided.
Sworn to and subscribed in my presence by
this
day of
yr
.
My commission expires
year
.
(seal)
X
X
CLERK, DEPUTY CLERK OF COURTS NOTARY
WITNESS BY DEALER OR SALESPERSON
BMV 3772 7/21 [17601081]
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
APPLICATION FOR DEALER ASSIGNMENT
POWER OF ATTORNEY TO TRANSFER OWNERSHIP AND ATTESTATION OF MILEAGE AND IDENTITY FOR THE TRANSFER OF OWNERSHIP OF
A VEHICLE OR WATERCRAFT TO OR FROM A MOTOR VEHICLE OR WATERCRAFT DEALER LICENSED BY CHAPTERS 4517/1547 PURSUANT
TO OHIO REVISED CODE 4505.032/1548.032 AND APPLICATION FOR CERTIFICATE OF TITLE.
ASSIGNMENT OF OWNERSHIP
I (we) certify the vehicle or watercraft or outboard motor described in this statement was delivered on
for the price of $
Is Seller a Minor?
Yes
No
to:
TRANSFEREE’S / BUYER’S PRINTED NAME
TRANSFEREE’S / BUYER’S PRINTED ADDRESS
Warning to transferor and transferee (seller and buyer). You are required by law to state the true selling price. A false statement is in violation of section
2921.13 of the Ohio Revised Code and is punishable by six months imprisonment and a fine of up to one thousand dollars or both. All transfers are audited
by the Department of Taxation. The seller and buyer must provide any information requested by the Department of Taxation. The buyer may be assessed
any additional tax found to be due.
PICTURE ID ISSUED FROM STATE OF
OPERATOR LICENSE NUMBER OR ID NUMBER
CURRENT TITLED OWNER(S) NAME
CONTROL NUMBER
YEAR
MAKE
MODEL
BODY TYPE
LENGTH
TITLE NUMBER
HP
CURRENT TITLE TYPE
THIS VEHICLE WAS A (IF APPLICABLE)
REGULAR
FORMER LAW ENFORCEMENT
SALVAGE
FORMER TAXI
VIN/WIN/MIN
OFF ROAD
FLOOD VEHICLE
Federal and State laws require that you state the mileage in connection with transfer of ownership. Failure to complete or providing false information may
result in fines and/or imprisonment.
,
I (we) certify to the best of my (our) knowledge that the odometer now reads
NO TENTHS MILES
and is the actual mileage of the vehicle unless one of the following statements is checked.
The mileage stated is in excess of the mechanical limits.
The odometer reading is not the actual mileage.
WARNING–ODOMETER DISCREPANCY
APPLICATION FOR CERTIFICATE OF TITLE (Type or Print in Ink) Fee of $5.00 for failure to apply for title within 30 days of assignment.
CHECK TYPE OF APPLICATION(S):
MOTOR VEHICLE
MEMORANDUM
WATERCRAFT
DUPLICATE (Check One)
OUTBOARD MOTOR
SALVAGE
REPLACEMENT
Lost
Stolen
Destroyed
APPLICANT’S PRINTED NAME
SSN/EIN
APPLICANT’S PRINTED STREET ADDRESS
CITY
STATE
ZIP CODE
COUNTY
VENDOR’S DISCOUNT
PURCHASE PRICE
TRADE IN ALLOWANCE
GROSS TAX DUE
$
$
$
$
DEALER’S PERMIT NUMBER
TAX PAID
TAX EXEMPTION:
YES
$
REASON
VENDOR’S NUMBER
CONDITION OF VEHICLE OR WATERCRAFT OR OUTBOARD MOTOR (CHECK ONLY ONE):
GOOD
FAIR
POOR
WRECKED
LIEN INFORMATION: If no lien, state “none”. If more than one lien, attach statement of all additional liens.
LIENHOLDER PRINTED NAME/E CODE #
ADDRESS
CITY
STATE
ZIP CODE
I (we) state that all information contained in this application is true and correct.
IS APPLICANT A MINOR?
YES
NO
APPLICANT’S SIGNATURE
PRINTED
NON PRINTED
X
TRANSFEREE’S / BUYER’S ACKNOWLEDGEMENT OF ABOVE ODOMETER CERTIFICATION AND/OR DUPLICATE TRANSACTIONS
TRANSFEREE’S / BUYER’S OR APPLICANT’S PRINTED NAME
TRANSFEREE’S / BUYER’S SIGNATURE
X
I/We, the current titled owner or applicant, appoint
as my true and lawful attorney-in-fact to execute any
and all application for assignment of Certificate of Title for the motor vehicle listed above. I attest to the above odometer reading.
I warrant the title to be free of all liens.
TRANSFEROR’S / SELLER’S PRINTED NAME
TRANSFEROR’S / SELLER’S SIGNATURE
X
TRANSFEROR’S / SELLER’S PRINTED ADDRESS
CITY
STATE
ZIP CODE
NOTE: All blank spaces above must be completed before acknowledgement. If not applicable, insert NA or NONE in the space provided.
Sworn to and subscribed in my presence by
this
day of
yr
.
My commission expires
year
.
(seal)
X
X
CLERK, DEPUTY CLERK OF COURTS NOTARY
WITNESS BY DEALER OR SALESPERSON
BMV 3772 7/21 [17601081]