Fillable Form Arizona Duplicate Title Application (96-0236)

What is the Arizona Duplicate Title Application Form?

Form HSMV 82101, Title and Registration Application, or also referred to as the Arizona Duplicate Title Application Form, is used by Arizona residents to apply for a duplicate certificate of title for their motor vehicles, mobile homes, trailers, or semi-trailers.

Arizona residents may request a title renewal, a duplicate title, or a vehicle registration in case their original certificate titles were lost, stolen, or damaged.

How to fill out the Arizona Duplicate Title Application Form?

Applicants can download and print a PDF copy of the Arizona Duplicate Title Application Form from the Arizona Department of Transportation (AzDOT) website that they can manually complete. They can also fill out the Arizona Duplicate Title Application Form electronically on PDFRun.

To fill out the Florida Duplicate Title Application Form, you must provide the following information:

Type of Application

Mark the appropriate box which corresponds to the type of application you are filing for. You may select:

• Title and registration
• Title only
• Duplicate
• Registration only
• Dismantle
• Salvage
• Stolen

Plate Number

Enter the plate number of your motor vehicle.

Plate Credit Number

Enter the plate credit number of your motor vehicle.

Credit Effective Date

Enter the credit effective date of your motor vehicle.

First Registered

Enter the date when your motor vehicle was first registered.

Registration Effective Date

Enter the registration effective date of your motor vehicle.

Registration Expiration Date

Enter the registration expiration date of your motor vehicle.

Unit Number

Enter the unit number of your motor vehicle.

Mobile Home Weight and Length

Enter the weight and length of your mobile home.

Vehicle Identification Number (VIN)

Enter the vehicle identification number (VIN) of your motor vehicle.

Make

Enter the make of your motor vehicle.

Body Style

Enter the body style of your motor vehicle.

Year

Enter the year or model cycle your motor vehicle is in.

Model

Enter the model of your motor vehicle.

List Price

Enter the list price of your motor vehicle in U.S. dollars.

Gross Vehicle Weight (GVW)

Enter the gross vehicle weight (GVW) of your motor vehicle.

Fuel

Enter the type of fuel your motor vehicle runs on.

Odometer Reading

Enter the odometer reading of your motor vehicle.

Odometer Codes

Mark the appropriate box which corresponds to the code of your odometer reading. You may select:

• A
• B
• C

Vehicle Construction

Mark the appropriate box which corresponds to how your motor vehicle was constructed. You may select:

• Specially constructed
• Reconstructed

Trailer Plate Size

Mark the appropriate box which corresponds to the trailer plate size of your motor vehicle. You may select:

• Full size
• Small

Lien Amount

Enter the amount of your lien in U.S. dollars.

Lien Date

Enter the date when the lien of your motor vehicle was issued.

Lienholder Driver’s License Number (DLN) or Employer Identification Number (EIN)

Enter the driver’s license number (DLN) or employer identification number (EIN) of your lienholder.

Lienholder Name

Enter the full legal name of your lienholder. If you do not have a lienholder or if your motor vehicle is not attached to a lien, enter the word “NONE.”

Additional Lien or Lienholders

Mark the box if there is an additional lien or if there are additional lienholders. If you marked the box, you are required to attach another Arizona Duplicate Title Application Form along with this form.

Legal Status

Mark the appropriate box which corresponds to the legal status of your lienholder. You may select:

• Or
• And
• And/or

Mailing Address

Enter the mailing address of your lienholder.

City

Enter the city of your lienholder.

State

Enter the state of your lienholder.

ZIP Code

Enter the ZIP code of your lienholder.

Owner Information

The instructions stated below will apply to all three parts of this section.

Owner Driver’s License Number (DLN) or Employer Identification Number (EIN)

Enter your driver’s license number (DLN) or employer identification number (EIN).

Owner Name

Enter your legal first name, middle name, last name, and suffix if it is applicable.

Date of Birth

Enter your date of birth.

Motor Vehicle Division (MVD) Tax Account Number

Enter your Motor Vehicle Division (MVD) tax account number if it is applicable.

Legal Status

Mark the appropriate box which corresponds to your legal status. You may select:

• Or
• And
• And/or

If you happen to mark “Or,” you are required to affix your signature.

Owner Signature

Affix your signature.

Street Address

Enter your street address.

City

Enter your city.

State

Enter your state.

ZIP Code

Enter your ZIP code.

County

Enter your county.

Mailing Address

Enter your mailing address.

City

Enter your city.

State

Enter your state.

ZIP Code

Enter your ZIP code.

County

Enter your county.

Vehicle or Mobile Home Location

Enter the location of your motor vehicle or mobile home.

City

Enter the city where your vehicle or mobile home is located.

State

Enter the state where your vehicle or mobile home is located.

ZIP Code

Enter the ZIP code where your vehicle or mobile home is located.

Service Options

Enter the service options for your motor vehicle or mobile home.

Date Vehicle Acquired

Enter the date when your motor vehicle or mobile number was acquired.

Rent

Mark the box if your motor vehicle or mobile home will be rented without a driver.

Consent

Mark the box if you consent to the release of the personal information contained in your driver’s license and motor vehicle record. You must understand that this is not a one-time consent that applies only to a specific individual or organization, but it is a general consent that applies to all requests from any and all individuals or organizations for any purpose until you decide to have it revoked in writing.

Certification

Mark the first box if you are certifying that your motor vehicle or mobile home 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.

Mark the second box if you certify that your trailer or semi-trailer with a declared gross weight of 10,000 pounds or less is not maintained and operated in the furtherance of a commercial enterprise.

All Owners Sign Here

Affix your signature along with the other owners.