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- Form 96-0236 "Title and Registration Application" - Arizona
Form 96-0236 "Title and Registration Application" - Arizona
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What Is Form 96-0236?
Form 96-0236, Title and Registration Application, is a form that has to be completed by residents of the State of Arizona to apply for an Arizona title and registration when they buy a vehicle. An Arizona vehicle registration allows its owner to operate their car on the state roads, and a title is a document that proves the ownership for a vehicle. The completed form should be submitted to an Arizona Motor Vehicle Division (MVD) Office or Authorized Third Party provider within 15 days of purchase.
Alternate Name:
- Arizona Title Application.
An Arizona Title and Registration Application should be filled in by new residents of the state to register their out-of-state vehicle if they wish to operate it in Arizona. In this case, the form must be submitted immediately after obtaining resident status. The applicant has to attach to the form an out-of-state title. Form 96-0236 can also be used to apply for a duplicate title if it is illegible or has been lost or mutilated. In these cases, an application can be mailed to the Arizona Motor Vehicle Division.
This form was released by the Arizona Department of Transportation and the latest version was issued on January 1, 2016. A fillable Form 96-0236 is available for download below.
How to Fill Out Arizona Title and Registration Application?
Arizona Form 96-0236 must be filled in as follows:
- The applicant has to check the purpose of an application.
- The applicant should enter information about a vehicle: its license plate number, identification number, year, model, fuel type, odometer reading, and construction. The applicant has to check the appropriate odometer codes using the Odometer reading codes description below the form.
- If there is a lien on a vehicle, information about it should be provided. Enter the lien amount and date, provide information about the lienholder, such as their driver's license number, name, legal status, and mailing address.
- Indicate information about the owner of a vehicle, such as their driver's license number, full name, and street address. Indicate the mailing address if it is different from the specified one. If there are several owners of a vehicle, provide information about each one, and choose on the Legal status box which signatures are necessary to transfer ownership or to record loan information. A detailed legal status description can be found below the form. If the applicant is acting on behalf of a company, their Federal Employer Identification Number (EIN) should be entered.
- The applicant should provide information about the home location of a vehicle and the date of its acquiring. Complete the section "Service Options" by entering the number for each applicable item, specified in the list below the form. All owners of a vehicle have to sign the form and certify that the information provided is correct.
- When the applicant applies to duplicate a title, information about the vehicle, lienholder, owner's name, and their legal status should remain the same. It is only allowed to change the address and vehicle location address. Regardless of the number of owners, only one owner should sign the form in this case.
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2TITLE AND REGISTRATION
APPLICATION
Clear
Title and Registration
Title Only
Duplicate
Registration Only
Dismantle
Salvage
Stolen
azdot.gov
96-0236 R
/1
Plate Number
Plate Credit No.
Credit Eff. Date
First Registered
Reg. Eff. Date
Reg. Expiration Date Unit Number
Mobile Home W/L
Vehicle Identification Number
Make
Body Style
Year
Model
List Price
$
GVW
Fuel
Odometer Reading (no tenths) Odometer Codes*
Vehicle Construction
Trailer Plate Size
A B C
Specially Constructed Reconstructed
Full Size Small
Lien Amount
Lien Date
Additional lien or lienholders (attach another application)
$
Lienholder Driver License or EIN*
Lienholder Name (if no lien, write NONE)
Legal Status
Or And And/Or
Mailing Address
City
State Zip
Owner Driver License or EIN*
Owner Name (first, middle, last, suffix)
Date of Birth
MVD Tax Account Number (if applicable)
Legal Status* (If “Or” is checked, owner must sign here.)
Or And And/Or Sign
Street Address
City
State Zip
County
Mailing Address (if different from above)
City
State Zip
County
Owner Driver License or EIN*
Owner Name (first, middle, last, suffix)
Date of Birth
MVD Tax Account Number (if applicable)
Legal Status* (If “Or” is checked here or above, owner must sign here.)
Or And And/Or Sign
Street Address
City
State Zip
County
Mailing Address (if different from above)
City
State Zip
County
Owner Driver License or EIN*
Owner Name (first, middle, last, suffix)
Additional owners (attach another application)
Date of Birth
MVD Tax Account Number (if applicable)
Legal Status* (If “Or” is checked here or above, owner must sign here.)
Or And And/Or Sign
Street Address
City
State Zip
County
Mailing Address (if different from above)
City
State Zip
County
Vehicle/Mobile Home Location
City
State Zip
County
Service Options*
Date Vehicle Acquired
I consent to the release of personal information contained in my driver license and vehicle record.
I understand that this is not a one-time consent that applies only to a specific individual or organization, but is
instead a general consent that applies to all requests from any and all individuals or organizations for any
Vehicle will be rented without a driver
purpose, until revoked by me in writing. Consent for a vehicle record applies to all owners.
(such as a rental car).
I certify that this vehicle, commonly referred to as a station wagon or referred to by the manufacturer’s rating as a 3/4 ton or less pickup truck or 3/4 ton or less
van, is not maintained and operated more than 1,000 hours in a vehicle registration year for the transportation of passengers or property in the furtherance of a
commercial enterprise.
I certify that this trailer or semitrailer with a declared gross weight of 10,000 lbs or less is not maintained and operated in the furtherance of a commercial
enterprise.
I certify that the information above and any documentation which I submit in support of this application, is true and correct; that the vehicle is free from liens, except
those indicated above and that I have read and understand the requirements of the legal status indicated above. I acknowledge that the odometer reading above is
qualified by the seller and that it is not the responsibility of the Motor Vehicle Division to determine the accuracy of the odometer statement. I understand that
vehicles registered for use in, or used to commute into, Air Quality Control Areas (including greater metro Phoenix and Tucson) may be subject to emission testing.
If “Or” is checked above, owners must also sign the Legal Status boxes above.
All Owners
Sign Here
Cat
Canceled Plate Number/State/Agent
Current Title Number
State
Date Title Issued
* See
MVD Use
Reverse
1
2 Plates
REG
EIF
TRN
AQF
PST
PEN
LOP
SNO
DOR
TTL
UTX
SPL
VLT
CRF
WGT
MCF
PRC
Total Fees
TITLE AND REGISTRATION
APPLICATION
Clear
Title and Registration
Title Only
Duplicate
Registration Only
Dismantle
Salvage
Stolen
azdot.gov
96-0236 R
/1
Plate Number
Plate Credit No.
Credit Eff. Date
First Registered
Reg. Eff. Date
Reg. Expiration Date Unit Number
Mobile Home W/L
Vehicle Identification Number
Make
Body Style
Year
Model
List Price
$
GVW
Fuel
Odometer Reading (no tenths) Odometer Codes*
Vehicle Construction
Trailer Plate Size
A B C
Specially Constructed Reconstructed
Full Size Small
Lien Amount
Lien Date
Additional lien or lienholders (attach another application)
$
Lienholder Driver License or EIN*
Lienholder Name (if no lien, write NONE)
Legal Status
Or And And/Or
Mailing Address
City
State Zip
Owner Driver License or EIN*
Owner Name (first, middle, last, suffix)
Date of Birth
MVD Tax Account Number (if applicable)
Legal Status* (If “Or” is checked, owner must sign here.)
Or And And/Or Sign
Street Address
City
State Zip
County
Mailing Address (if different from above)
City
State Zip
County
Owner Driver License or EIN*
Owner Name (first, middle, last, suffix)
Date of Birth
MVD Tax Account Number (if applicable)
Legal Status* (If “Or” is checked here or above, owner must sign here.)
Or And And/Or Sign
Street Address
City
State Zip
County
Mailing Address (if different from above)
City
State Zip
County
Owner Driver License or EIN*
Owner Name (first, middle, last, suffix)
Additional owners (attach another application)
Date of Birth
MVD Tax Account Number (if applicable)
Legal Status* (If “Or” is checked here or above, owner must sign here.)
Or And And/Or Sign
Street Address
City
State Zip
County
Mailing Address (if different from above)
City
State Zip
County
Vehicle/Mobile Home Location
City
State Zip
County
Service Options*
Date Vehicle Acquired
I consent to the release of personal information contained in my driver license and vehicle record.
I understand that this is not a one-time consent that applies only to a specific individual or organization, but is
instead a general consent that applies to all requests from any and all individuals or organizations for any
Vehicle will be rented without a driver
purpose, until revoked by me in writing. Consent for a vehicle record applies to all owners.
(such as a rental car).
I certify that this vehicle, commonly referred to as a station wagon or referred to by the manufacturer’s rating as a 3/4 ton or less pickup truck or 3/4 ton or less
van, is not maintained and operated more than 1,000 hours in a vehicle registration year for the transportation of passengers or property in the furtherance of a
commercial enterprise.
I certify that this trailer or semitrailer with a declared gross weight of 10,000 lbs or less is not maintained and operated in the furtherance of a commercial
enterprise.
I certify that the information above and any documentation which I submit in support of this application, is true and correct; that the vehicle is free from liens, except
those indicated above and that I have read and understand the requirements of the legal status indicated above. I acknowledge that the odometer reading above is
qualified by the seller and that it is not the responsibility of the Motor Vehicle Division to determine the accuracy of the odometer statement. I understand that
vehicles registered for use in, or used to commute into, Air Quality Control Areas (including greater metro Phoenix and Tucson) may be subject to emission testing.
If “Or” is checked above, owners must also sign the Legal Status boxes above.
All Owners
Sign Here
Cat
Canceled Plate Number/State/Agent
Current Title Number
State
Date Title Issued
* See
MVD Use
Reverse
1
2 Plates
REG
EIF
TRN
AQF
PST
PEN
LOP
SNO
DOR
TTL
UTX
SPL
VLT
CRF
WGT
MCF
PRC
Total Fees
Odometer Reading Codes
A
The mileage stated reflects the actual mileage.
B
The mileage stated is in excess of the odometer's mechanical limits.
C
The odometer reading is not the actual mileage.
–
WARNING
ODOMETER DISCREPANCY
Legal Status
When ownership of the vehicle is in more than one name, the Legal Status box determines which signatures will be required to transfer
ownership of the vehicle, license plates and/or fees, to apply for a refund, or to record loan information.
OR
Ownership is joint tenancy, with an expressed intent that either of the owners has full authority to transfer ownership, license plates
JOHN DOE OR JOE ROSS
and/or fees, or to record loan information. Names will appear on the title as in this example:
Signature of either party will be accepted. Both signatures are not required. Owners must sign the Legal Status boxes.
JOHN DOE AND JOE ROSS
AND
Ownership is tenancy in common. Names will appear on the title as in this example:
Signatures of both parties will be required. In the event of the death of either party, the interest of the deceased party must be handled
by probate action, or by completing a Non-Probate Affidavit.
/
JOHN DOE AND/OR JOE ROSS
AND
OR
Ownership is joint tenancy with right of survivorship. Names will be on the title as in this example:
Signatures of both parties will be required, if both are living. Upon proof of death, the survivor may sign alone.
Driver License Number or EIN
You are required to provide your driver license number or MVD assigned Customer Number. If in the name of a company, provide your
Federal Employer Identification Number (EIN) assigned by the Internal Revenue Service, or MVD assigned Customer Number.
Service Options
In the Service Options box, enter the number for each item that applies to you. Additional documentation may be required.
Alternative Fuel – Vehicle is powered by liquefied petroleum gas (LPG, propane), natural gas (CNG/LNG), a blend of 70% alternative fuel and 30%
1.
petroleum-based fuel, hydrogen, solar or electric (excluding golf carts).
Tribal – You are an enrolled member of a tribe and live on a reservation.
2.
VA Grant – You received financial aid from the U.S. Department of Veterans Affairs to purchase your vehicle.
3.
VA Disability – You are certified by the U.S. Department of Veterans Affairs to be 100% disabled and drawing compensation on that basis. The
4.
exemption also applies to the surviving spouse, until remarriage.
Widow/Totally Disabled Person – You receive a widow, widower or totally disabled person, property tax exemption from your county assessor.
5.
Military – You are a nonresident military person.
6.
Special Military – Certain Arizona resident who are members of the US Armed forces.
7.
Survivor of Fallen Military Member – A Surviving Spouse or a Surviving Dependent of a Fallen Military Member.
8.
Non-Government Emergency Services – You are a private provider of ambulance, fire fighter or rescue services, and your vehicle is used solely for
9.
emergency services.
10. Survivor of Fallen Responder – A Surviving Spouse or a Surviving Dependent of a Law Enforcement Officer, Fire Fighter, or Emergency Responder
who died in the line of duty on or after 04/05/1933.
11. Nonprofit – You receive a non-profit, property tax exemption from your county assessor.
12. School or Church – You receive a non-profit school or church property tax exemption from your county assessor.
13. SSI – You receive Supplemental Security Income disability payments from the federal government. This is not regular Social Security disability benefits.
14. Leased School Bus – Vehicle is a bus leased by a school district.
15. Health Officer – You are a public health commissioned officer assigned to a government clinic or medical center.
— Commercial Use / Motor Carrier Options —
16. One-Way Hauling – At least 45% of the vehicle mileage during the registration year is traveled without a load.
17. Route Truck – Vehicle weighs more than 26,000 lbs and begins and ends a trip at the same point without adding to the load. At the midway point, the
load must be less than 45% of the full load capacity of the vehicle.
18. Agricultural Products – Vehicle is used only for transporting agricultural products, such as crops, machinery, supplies or livestock used or produced in
farming operations. The products, crops or livestock must be unmanufactured or unprocessed.
19. For Hire – Vehicle is 12,000 lbs or less and you receive compensation for transporting people or property.
20. Farm Vehicle – Vehicle is used in commercial farming or stock raising by the farmer, family member or an employee.
21. Motion Picture Production – Vehicle is used in the production of motion pictures, commercials or films.
22. Limited Mileage I – Vehicle weighs more than 26,000 lbs and is driven less than 2,000 miles each year.
23. Limited Mileage II – Vehicle weighs more than 26,000 lbs and is driven 2,000 or more miles, but less than 4,000 miles each year.
Vehicle License Tax Distribution
Revenues from the Vehicle License Tax are distributed as follows:
State Highways 22.72%, County Roads 14.38%, City Roads 13.72%,
County General Fund 24.59% and City/Town General Fund 24.59%.
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Most popular documents
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DA Form 2062 "Hand Receipt/Annex Number"
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"Vsepr Theory (Molecular Shapes) Chart"
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"Zappos Kid Shoe Size Chart"
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DD Form 2813
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DD Form 2977 "Deliberate Risk Assessment Worksheet"
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DA Form 31 "Request and Authority for Leave"
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DD Form 1750 "Packing List"
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AF Form 910 "Enlisted Performance Report (AB Thru Tsgt)"
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DA Form 3595 "Record Fire Scorecard"
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DD Form 2923 "Privacy Act Data Cover Sheet"
Popular Articles
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- Washington State Patrol Inspection Request Form Washington State Patrol Inspection Request Form
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- USCIS Form I-797C, Notice of Action USCIS Form I-797C, Notice of Action
- Form REG 124, Application for Assigned Vehicle Identification Number Plate Form REG 124, Application for Assigned Vehicle Identification Number Plate
- Form VSD 190, Application for Vehicle Transaction(s) Form VSD 190, Application for Vehicle Transaction(s)
- Form DOS-1246, Security Guard Renewal Application Form DOS-1246, Security Guard Renewal Application
- Form REG 262, Vehicle/Vessel Transfer and Reassignment Form REG 262, Vehicle/Vessel Transfer and Reassignment
