Manufacturing                                                                                          Title
Model ____________________________________________________ Number _______________________________________________

Tag/Vessel or                                                                           Registration                                                   Expiration
Motor Number ____________________________________ Decal Number ________________________ Month/Year ________________

Owner's                                                                         Date                                      Title Receipt
Name ______________________________________ Issued __________________ Number _____________________________________

Mailing
Address _________________________________________ City _______________________ State _____________ Zip ______________

Lien in                                                                                                                          Lien
Favor of _________________________________________ City _______________ State _________ Date __________ Time _________

Lien in                                                                                                                          Lien
Favor of _________________________________________ City _______________ State _________ Date __________ Time _________

Reason for Requiring
this Duplicate Title: _______________________________________________________________________________________________
I, the undersigned lawful owner of the above described vehicle, hereby make application for a duplicate Certificate of Title full knowledge
that any false statement may subject me to prosecution.

Driver License
Number ________________________________________ Name ___________________________________________________________
                                                                                                                   (record owner must sign)

State of Oklahoma, County of ________________________________ §:

Subscribed and sworn to before me this ___________ day of __________________________________ , ________________

My commission expires __________________________.     __________________________________________________ , Notary Public.

Submitted by: ___________________________________________ Motor License Agent Number ________________________________

Oklahoma Tax Commission approved by ______________________________________________________________________________