Form BMV3754 "Ownership Assignment and Title Application for Insurance Companies" - Ohio

What Is Form BMV3754?

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 BMV3754 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 BMV3754 "Ownership Assignment and Title Application for Insurance Companies" - Ohio

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OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
OWNERSHIP ASSIGNMENT AND TITLE APPLICATION FOR
INSURANCE COMPANIES
Power of attorney to transfer ownership and attestation of mileage and identity for the transfer of ownership of a vehicle from a person to
an insurance company by chapter 4505 pursuant to Ohio Revised Code (R.C.) 4505.07 / 4505.11 and application for certificate of title.
 For scenarios that fall under R.C. 4505.11(C)(1)(b): The “Vehicle Information” and “Application for Certificate of Title” sections should be completed.
 For scenarios that fall under R.C. 4505.11(C)(1)(c): All sections on this form should be completed (any exceptions are noted below).
VEHICLE INFORMATION
(Type or Print in Ink.)
YEAR
MAKE
MODEL
BODY TYPE
VIN
TITLE NUMBER
CONTROL NUMBER
POWER OF ATTORNEY
(Note: If a separate Power of Attorney, or appropriate document, is submitted, the information in this box does not need to be completed.)
I (we), the current titled owner, 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.
TRANSFEROR’S / SELLER’S PRINTED NAME
TRANSFEROR’S / SELLER’S PRINTED ADDRESS
CITY
STATE
ZIP
TRANSFEROR’S / SELLER’S SIGNATURE
DATE
X
ASSIGNMENT OF OWNERSHIP
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’S PRINTED NAME
TRANSFEREE / BUYER’S PRINTED ADDRESS
CITY
STATE
ZIP
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 R.C. and is punishable by six months imprisonment or 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 due.
ODOMETER CERTIFICATION 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.
CHECK ONE
I (we) certify to the best of my (our) knowledge that the odometer now reads:
Actual Mileage
The Mileage stated is in EXCESS of the Mechanical Limits
miles (no tenths)
,
The odometer reading is not the actual Mileage.
WARNING Odometer Discrepancy
thousands
Seller is a minor:
YES
NO
TRANSFEROR / SELLER’S PRINTED NAME
TRANSFEROR / SELLER’S PRINTED ADDRESS
CITY
STATE
ZIP
TRANSFEROR / 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
BUYER ACKNOWLEDGEMENT OF ABOVE ODOMETER CERTIFICATION
TRANSFEREE / BUYER’S PRINTED NAME
TRANSFEREE / BUYER’S SIGNATURE
DATE
X
BMV 3754 7/21 [760-1503] Page 1 of 2
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
OWNERSHIP ASSIGNMENT AND TITLE APPLICATION FOR
INSURANCE COMPANIES
Power of attorney to transfer ownership and attestation of mileage and identity for the transfer of ownership of a vehicle from a person to
an insurance company by chapter 4505 pursuant to Ohio Revised Code (R.C.) 4505.07 / 4505.11 and application for certificate of title.
 For scenarios that fall under R.C. 4505.11(C)(1)(b): The “Vehicle Information” and “Application for Certificate of Title” sections should be completed.
 For scenarios that fall under R.C. 4505.11(C)(1)(c): All sections on this form should be completed (any exceptions are noted below).
VEHICLE INFORMATION
(Type or Print in Ink.)
YEAR
MAKE
MODEL
BODY TYPE
VIN
TITLE NUMBER
CONTROL NUMBER
POWER OF ATTORNEY
(Note: If a separate Power of Attorney, or appropriate document, is submitted, the information in this box does not need to be completed.)
I (we), the current titled owner, 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.
TRANSFEROR’S / SELLER’S PRINTED NAME
TRANSFEROR’S / SELLER’S PRINTED ADDRESS
CITY
STATE
ZIP
TRANSFEROR’S / SELLER’S SIGNATURE
DATE
X
ASSIGNMENT OF OWNERSHIP
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’S PRINTED NAME
TRANSFEREE / BUYER’S PRINTED ADDRESS
CITY
STATE
ZIP
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 R.C. and is punishable by six months imprisonment or 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 due.
ODOMETER CERTIFICATION 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.
CHECK ONE
I (we) certify to the best of my (our) knowledge that the odometer now reads:
Actual Mileage
The Mileage stated is in EXCESS of the Mechanical Limits
miles (no tenths)
,
The odometer reading is not the actual Mileage.
WARNING Odometer Discrepancy
thousands
Seller is a minor:
YES
NO
TRANSFEROR / SELLER’S PRINTED NAME
TRANSFEROR / SELLER’S PRINTED ADDRESS
CITY
STATE
ZIP
TRANSFEROR / 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
BUYER ACKNOWLEDGEMENT OF ABOVE ODOMETER CERTIFICATION
TRANSFEREE / BUYER’S PRINTED NAME
TRANSFEREE / BUYER’S SIGNATURE
DATE
X
BMV 3754 7/21 [760-1503] Page 1 of 2
APPLICATION FOR CERTIFICATE OF TITLE
(Type or Print in Ink) Additional fee of $5.00 for failure to apply for title within 30 days of assignment.
Check Type of Title Requested
(Check One)
Salvage
Salvage Replacement
Salvage Duplicate
Lost
Stolen
Destroyed
APPLICANT’S / BUYER’S PRINTED NAME
SSN / EIN
APPLICANT’S / BUYER’S PRINTED ADDRESS
CITY
STATE
ZIP
COUNTY
PURCHASE PRICE
TAX PAID
IF TAX EXEMPT, STATE REASON
VENDOR NUMBER
$
$
Condition of Vehicle (Check Only One)
Good
Fair
Poor
Wrecked
Print Title
YES
NO
Lien Information: If no lien, state “none”. If more than one lien, attached statement of all additional liens.
LIENHOLDER’S PRINTED NAME
LIENHOLDER’S ADDRESS
CITY
STATE
ZIP
NOTE: All blank spaces above must be completed before acknowledgement. If not applicable, insert NA or NONE in the space provided.
I (we) state that all information contained in this application is true and correct.
APPLICANT’S / BUYER’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
BMV 3754 7/21 [760-1503] Page 2 of 2
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