MAKE
YEAR
VEHICLE IDENTIFICATION NUMBER TITLE NUMBER
Owner's Last Name
FIRST NAME(S) MIDDLE NAME
Street, RFD
CITY STATE
ZIP
CERTIFICATION
I/We, the registered owner or lienholder of the above described vehicle, hereby make application for a Replacement Certificate of Title and certify that the
original has been
(Check appropriate box.)
Lost Never received from the Department
Mutilated, Destroyed or Illegible: Stolen;
Never received from the Lienholder;
Other (State why replacement is applied for if none of above apply)
MADE BY OWNER:
If a lienholder was shown on the original title, a lien release must be included with this replacement
application. Application must be signed by owner (s). If title is in a business name, person signing application must list
their position in the company next to their signature.
Example: John Doe, President
Applicant hereby directs the Department of Revenue to mail or deliver the title herein applied for as shown below.
COMPLETE THIS SECTION, PRINTING OR TYPING ALL INFORMATION
IF NAME
ENTERED HERE
IS OTHER
THAN TITLE
OWNER.
ATTACH
APPROPRIATE
POWER OF
ATTORNEY.
DEALERS
ATTACH COPY 3
OF FORM
78-004.
OTHERS USE
78-003.
Fee for Replacement Title is payable by Cashier's Check,
Personal Check, Certified Check or other form of Certified funds.
(NAME)
(STREET / APT. / P.O. BOX)
CITY STATE ZIP
I, the undersigned hereby certify that I am the recorded owner or lienholder of the above described vehicle.
Owner's Signature
Joint Owner's Signature
Lienholder's Name
Agent
(Signature of Lienholder Authorized Representative)
Date
,20
MONTH DAY YEAR
Application for Replacement Certificate of Title
READ &
CHECK
HERE
SEE INSTRUCTIONS ON
REVERSE SIDE OF FORM
FEE OF $9.00
Form 78-006-17-8-1-000 (Rev. 07/17)
TO: MISSISSIPPI DEPARTMENT OF REVENUE
MOTOR VEHICLE SERVICES
P.O. BOX 1383 JACKSON, MS 39215-1383
I/We understand that upon issuance of the replacement title, the original title becomes void and must be returned to the Department of
Revenue should it be found. I/We also understand the replacement title shall contain the legend "this is a replacement certificate and
may be subject to the rights of a person under the original certificate."
MADE BY LIENHOLDER:
If lienholder directs Department of Revenue to mail title to owner, a lien release must be
included and owner(s) must sign application. If no lien release is provided and owner(s) does not sign, replacement
title will be mailed to lienholder as shown on title.
780061781000
Instructions and Tips On Replacement Title Request
Complete all information and mail to:
Mississippi Department of Revenue
Motor Vehicle Services
P. O. Box 1383
Jackson, MS 39215-1383
If you need a copy of this form for your records you may make a photocopy, this
original application will not be returned to you.
Form 78-006-17-8-2-000 (Rev. 07/17)
1. Only apply for a replacement title if you are certain there was a previous Mississippi title.
2. Application for replacement title (78-006) requires a fee of $9.00.
3.
Application for
FAST TRACK
Replacement Certificate of Title (78-026) requires a fee of
$39.00.
If the replacement title is to be mailed to anyone other than the owner, you must submit a
power of attorney, executed by the owner, authorizing us to do so; and the person
holding 'power of attorney must sign application and indicate "P.O.A."
Licensed dealers
must
use the Secure Power of Attorney Form 78-004.
5. If the current title was issued in joint ownership with the names joined by "and" both
signatures are required on the replacement application.
6. If a lien shows on th
e Department of Revenue's computer system, the replacement title can
only be
mailed or given to the li
enholder, unless a completed lien release is provided by the
lienholder. If the lienholder has gone out of business or changed names and the loan has
been paid in full, it is still the owner's responsibility to obtain a lien release.
7. Once a replacement title is issued, the original title becomes
VOID.
If the original title
is later found it should be surrendered to the Department of Revenue.
4.
