315804 9/12/2017 (9)
CITY OF CARMEL, INDIANA VENDOR: 00351239ONE CIVIC SQUARE BUREAU OF MOTOR VEHICLES CHECK AMOUNT: S`***``**15.00*
CARMEL, INDIANA 46032 CENTRAL OFFICE MUNICIPAL PROCESSING CHECK NUMBER: 315804
100 N SENATE AVE,ROOM N415 CHECK DATE: 09/12/17
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 15.00 OTHER EXPENSES
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STATE OF INDIANA
Eric J. Holcomb, Governor Peter L. Lacy,Commissioner
MUNICIPAL CORPORATION AND LAW ENFORCEMENT
Vehicle Title and Registration Application Checklist
Title and registration applications for municipal corporations,including law enforcement,must be processed by the BMV
Municipal Processing department..Prior to submitting each application, verify all required information is included.
Contact(888)692-6841 with any questions.
When submitting paperwork, include the following:
Title Application Reauiremen c
X Application for Certificate of Title for a Vehicle—State Form 205
?� Original certificate of title or manufacturer's certificate of origin
Physical Inspection of a Vehicle or Watercraft—State Form 39530 Required for vehicles purchased outside
of Indiana.
X Odometer Disclosure Statement—State Form 43230(if odometer statement is not completed on the
certificate of title or certificate or origin). Trailers and vehicles over 16,000 pounds are exempt.
7K ST108E—Certificate of Gross Retail or Use Tax Exemption—State Form 48841
Submit payment for the following vehicle title application fees and taxes. Payable by MasterCard or Visa,
check,electronic check,or money order.
o $15 title application fee.
o $30 additional administrative penalty will be assessed if the title application packet is not received
within 45 days after the date of purchase.
o $25 speed title fee. This optional fee is in addition to the$15 title application fee. Paying the
optional speed title fee ensures that the title is processed in a period of time that is substantially
shorter than the normal processing period.
i Vehicle color: (List color on line)
Reaistration Application Reauirements
X Application for New and/or Transferred License Plates for Municipal Corporations and Law Enforcement—
State Form 53565
k Copy of Indiana certificate of title or Application for Certificate of Title for a Vehicle—State Form 205(if
already titled to applicant)
Copy of the lease agreement or Statement of Existing Lease Agreement—State Form 12787(if the vehicle
is being leased from a leasing company)
Safety inspection completed by ISP for all municipally owned school buses
For your convenience,the required forms are included with this checklist. The forms are also available at myBMV.com.
Mail the completed packet to:
Indiana Bureau of Motor Vehicles
Central Office Municipal Processing
100 North Senate Avenue,Room N415
Indianapolis,IN 46204
If the BMV determines that sufficient credible evidence exists to substantiate the applicant's claim of ownership,a
title/registration will be issued. If all required documents are not submitted or information Is incomplete.the entire
2oplic2tion will be returned.
Please Include this checklist with your application.