Form PS2004-2 "Application for Transfer-On-Death Beneficiary" - Minnesota

What Is Form PS2004-2?

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

Form Details:

  • Released on September 1, 2017;
  • The latest edition provided by the Minnesota 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 fillable version of Form PS2004-2 by clicking the link below or browse more documents and templates provided by the Minnesota Department of Public Safety.

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Download Form PS2004-2 "Application for Transfer-On-Death Beneficiary" - Minnesota

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MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Print Form
DRIVER AND VEHICLE SERVICES
445 Minnesota Street,Saint Paul, MN 55101-5185
Phone: (651) 297-2126 TTY: (651) 282-6555
dvs.dps.mn.gov
Ap pl ic at io n fo r Tra ns f e r- on-Death Be neficia ry
Reference: Minnesota Statute Chapter 168A.125.
Instructions
1. Owner Information: Complete the owner information, listing all owners name, address, date of birth and driver license or
identification card number.
2. Beneficiary Designation: Complete the beneficiary designation including name, address, date of birth and driver license or
identification card number. If the beneficiary is an entity the name and address is required.
3. Motor Vehicle Information: Complete the motor vehicle information.
4. Spousal Consent: If required, complete the spousal consent (Section E) and have the signature notarized.
5. Vehicle Owner Acknowledgment: Read and initial all of the owner acknowledgement statements and sign and have the
signature notarized.
6. Application for Title: The Transfer on Death Beneficiary designation is not a title application. You must complete and
include the Application for Motor Vehicle Title, PS2000 with the Transfer on Death designation.
Important Notes: DVS recommends the vehicle owner should keep a copy of this beneficiary application with other important documents. A
motor vehicle title will not be provided to the beneficiary. Ownership of the vehicle will transfer to the beneficiary upon the death of the owner
or the last survivor of joint ownership with rights to survivorship, subject to the rights of secured creditors. To remove a beneficiary, you must
apply for a new title. Please be aware that Driver and Vehicle Services cannot provide legal or estate planning advice; please see a licensed
attorney.
A. Owner Information
DL/ID Number:
Owner 1: Last, First, Middle
Date of Birth:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
Owner 2 (If applicable): Last, First, Middle
Date of Birth:
DL/ID Number:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
DL/ID Number:
Owner 3 (If applicable): Last, First, Middle
Date of Birth:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
B. Designation of Transfer on Death Beneficiary (When the beneficiary is a person)
Beneficiary Information: Last, First, Middle
Date of Birth:
DL/ID Number:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
C. Designation of Transfer on Death Beneficiary (When the beneficiary is an entity)
Beneficiary Information: Entity name
STREET ADDRESS
CITY
STATE
ZIP CODE
Page 1 of 2
PS2004-2 Rev. 09/2017
MINNESOTA DEPARTMENT OF PUBLIC SAFETY
Print Form
DRIVER AND VEHICLE SERVICES
445 Minnesota Street,Saint Paul, MN 55101-5185
Phone: (651) 297-2126 TTY: (651) 282-6555
dvs.dps.mn.gov
Ap pl ic at io n fo r Tra ns f e r- on-Death Be neficia ry
Reference: Minnesota Statute Chapter 168A.125.
Instructions
1. Owner Information: Complete the owner information, listing all owners name, address, date of birth and driver license or
identification card number.
2. Beneficiary Designation: Complete the beneficiary designation including name, address, date of birth and driver license or
identification card number. If the beneficiary is an entity the name and address is required.
3. Motor Vehicle Information: Complete the motor vehicle information.
4. Spousal Consent: If required, complete the spousal consent (Section E) and have the signature notarized.
5. Vehicle Owner Acknowledgment: Read and initial all of the owner acknowledgement statements and sign and have the
signature notarized.
6. Application for Title: The Transfer on Death Beneficiary designation is not a title application. You must complete and
include the Application for Motor Vehicle Title, PS2000 with the Transfer on Death designation.
Important Notes: DVS recommends the vehicle owner should keep a copy of this beneficiary application with other important documents. A
motor vehicle title will not be provided to the beneficiary. Ownership of the vehicle will transfer to the beneficiary upon the death of the owner
or the last survivor of joint ownership with rights to survivorship, subject to the rights of secured creditors. To remove a beneficiary, you must
apply for a new title. Please be aware that Driver and Vehicle Services cannot provide legal or estate planning advice; please see a licensed
attorney.
A. Owner Information
DL/ID Number:
Owner 1: Last, First, Middle
Date of Birth:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
Owner 2 (If applicable): Last, First, Middle
Date of Birth:
DL/ID Number:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
DL/ID Number:
Owner 3 (If applicable): Last, First, Middle
Date of Birth:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
B. Designation of Transfer on Death Beneficiary (When the beneficiary is a person)
Beneficiary Information: Last, First, Middle
Date of Birth:
DL/ID Number:
-
-
-
-
STREET ADDRESS
CITY
STATE
ZIP CODE
C. Designation of Transfer on Death Beneficiary (When the beneficiary is an entity)
Beneficiary Information: Entity name
STREET ADDRESS
CITY
STATE
ZIP CODE
Page 1 of 2
PS2004-2 Rev. 09/2017
D. Motor Vehicle Information
Vehicle Year & Make:
Model:
Vehicle Identification Number:
State License Plate Issued From:
Plate Number:
E. Spousal Consent
Per Minnesota Statute 168A.125, if the owner of the motor vehicle is married at the time of the designation, then designation of a
beneficiary other than the owner's spouse requires the spouse's written consent.
I,
spouse of,
, offer my
unconditional consent to have
, listed as Transfer-on-Death beneficiary of
the above mentioned motor vehicle.
Signature of Spouse
Date:
Notary Information
(Required with spousal signature)
Subscribed and sworn before me this ______, day of __________________________, _________.
My Commission expires
/
/
(Seal)
Notary Public Signature
F. Vehicle Owner Acknowledgement
By initialling each statement and signing below before a notary I acknowledge:
MS§
There is no ownership interest in the motor vehicle until death of the owner or last survivor of joint ownership. (
. 168A.125 Subd. 3)
MS§
MS§
Ownership of the vehicle upon death is subject to the rights of all secured parties (
. 168A.125 Subd. 4 and 5) and any surviving spouse (
.
524.2-403).
If no beneficiary or beneficiaries survive me, the vehicle must be included in the probate of the deceased owner(s). (MS§ . 168A.125 Subd. 4)
MS§
Transfer of a motor vehicle to a Transfer-on-Death Beneficiary is not a testamentary transfer. (
. 168A.125 Subd. 4)
That the State or a County agency with a claim or lien authorized by section 246.53, 256B.15, 261.04, or 270C.63 is a creditor for the purposes of
Transfer-on-Death and that a claim authorized by the section 256B.15 against the estate of an owner voids any Transfer-on-Death conveyance. (MS§
168A.125 subd. 5b).
The acquisition of a motor vehicle by Transfer-on-Death is exempt from the payment of motor vehicle sales tax. (MS§ . 279B.01 subd. 16 (c)(1))
Date:
Signature of Owner
Notary Information
(Required)
Subscribed and sworn before me this ______, day of __________________________, _________.
My Commission expires
/
/
(Seal)
Notary Public Signature
PS2004-2 Rev. 09/2017
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