Form BMV3769 "Ownership Assignment to Surrender a Motor Vehicle for Destruction Only" - Ohio

What Is Form BMV3769?

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 BMV3769 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 BMV3769 "Ownership Assignment to Surrender a Motor Vehicle for Destruction Only" - Ohio

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OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
OWNERSHIP ASSIGNMENT TO SURRENDER A MOTOR VEHICLE
FOR DESTRUCTION ONLY
Section 4505.11 of the Ohio Revised Code (R.C.)
THIS FORM MAY BE USED WHEN ALL OF THE FOLLOWING APPLY
The certificate of title is being held electronically: no physical (paper) certificate of title has been issued.
The electronic title is being transferred and neither the seller nor the buyer is an Insurance company.
The current owner/seller must be one of the following:
o
Private owner transferring title to a salvage dealer, or
o
Self-insured organization, rental or leasing company, or secured creditor transferring title to a salvage dealer or
scrap metal processing facility.
By signing this assignment form, you are designating this vehicle as junk and that the vehicle can NEVER be registered
or retitled for use on the road or highways in any state.
VEHICLE INFORMATION
(Type or Print in Ink.)
YEAR
MAKE
MODEL
BODY TYPE
VIN
TITLE NUMBER
CONTROL NUMBER
OWNER INFORMATION
as listed on the current title
(
)
CURRENT OWNER(S) PRINTED NAME
CURRENT OWNER(S) ADDRESS
CITY
STATE
ZIP
ASSIGNMENT OF OWNERSHIP BY CURRENT OWNER / SELLER
This vehicle was a (if applicable)
Law Enforcement Vehicle
Flood Vehicle
Taxi
I (we) certify the vehicle described in this document was transferred on
for the price of $
to:
DATE
TRANSFEREE / BUYER PRINTED NAME
SALVAGE DEALER NUMBER / SCRAP METAL PROCESSING FACILITY EIN
TRANSFEREE / BUYER PRINTED ADDRESS
CITY
STATE
ZIP
I / We, the above identified current owner(s), affirm that:
 I have the legal right to sell the above described vehicle.
 No liens are outstanding against this vehicle.
 All information contained in this assignment form is true and correct.
CURRENT OWNER(S) / SELLER’S SIGNATURE
DATE
X
Notary:
Sworn to and subscribed in my presence this
day of
, 20
in
County,
State of
.
(Notary Seal)
X
My commission expires
Signature of Notary Public or other Authorized Officer by law
I (we) state that all information contained in this application is true and correct.
DESIGNEE’S SIGNATURE OF SALVAGE DEALER OR SCRAP METAL PROCESSING FACILITY
DATE
X
BMV 3769 7/21 [17601081]
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
OWNERSHIP ASSIGNMENT TO SURRENDER A MOTOR VEHICLE
FOR DESTRUCTION ONLY
Section 4505.11 of the Ohio Revised Code (R.C.)
THIS FORM MAY BE USED WHEN ALL OF THE FOLLOWING APPLY
The certificate of title is being held electronically: no physical (paper) certificate of title has been issued.
The electronic title is being transferred and neither the seller nor the buyer is an Insurance company.
The current owner/seller must be one of the following:
o
Private owner transferring title to a salvage dealer, or
o
Self-insured organization, rental or leasing company, or secured creditor transferring title to a salvage dealer or
scrap metal processing facility.
By signing this assignment form, you are designating this vehicle as junk and that the vehicle can NEVER be registered
or retitled for use on the road or highways in any state.
VEHICLE INFORMATION
(Type or Print in Ink.)
YEAR
MAKE
MODEL
BODY TYPE
VIN
TITLE NUMBER
CONTROL NUMBER
OWNER INFORMATION
as listed on the current title
(
)
CURRENT OWNER(S) PRINTED NAME
CURRENT OWNER(S) ADDRESS
CITY
STATE
ZIP
ASSIGNMENT OF OWNERSHIP BY CURRENT OWNER / SELLER
This vehicle was a (if applicable)
Law Enforcement Vehicle
Flood Vehicle
Taxi
I (we) certify the vehicle described in this document was transferred on
for the price of $
to:
DATE
TRANSFEREE / BUYER PRINTED NAME
SALVAGE DEALER NUMBER / SCRAP METAL PROCESSING FACILITY EIN
TRANSFEREE / BUYER PRINTED ADDRESS
CITY
STATE
ZIP
I / We, the above identified current owner(s), affirm that:
 I have the legal right to sell the above described vehicle.
 No liens are outstanding against this vehicle.
 All information contained in this assignment form is true and correct.
CURRENT OWNER(S) / SELLER’S SIGNATURE
DATE
X
Notary:
Sworn to and subscribed in my presence this
day of
, 20
in
County,
State of
.
(Notary Seal)
X
My commission expires
Signature of Notary Public or other Authorized Officer by law
I (we) state that all information contained in this application is true and correct.
DESIGNEE’S SIGNATURE OF SALVAGE DEALER OR SCRAP METAL PROCESSING FACILITY
DATE
X
BMV 3769 7/21 [17601081]