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The Iowa 411179 form is a critical document for anyone involved in leasing vehicles in the state. This form serves as the application for a certificate of title and/or registration specifically for leased vehicles, ensuring that all necessary information is collected and verified. It requires details about the owner, the lessee, and the vehicle itself, including the vehicle identification number (VIN), make, model, and weight classifications. Additionally, it addresses security interests and liens, which are essential for protecting the financial interests of all parties involved. Users must also indicate their registration preferences, whether the renewal should go to the owner or the lessee, and specify any exemptions from registration fees. With sections dedicated to both owner and lessee information, the form accommodates multiple lessees, making it versatile for various leasing arrangements. Completing this form accurately is vital; any inaccuracies could lead to delays or complications in the registration process. Overall, the Iowa 411179 form is designed to streamline the leasing process while ensuring compliance with state regulations.

Iowa 411179 Preview

APPLICATION FOR CERTIFICATE OF TITLE AND/OR REGISTRATION FOR A LEASED VEHICLE

Form 411179 (12-08)

(Check One) Send the registration renewal to the:

Owner

Lessee

Registration Month ___________

 

(Check One) Registration refunds shall be made payable to the:

Owner

Lessee

OWNER INFORMATION (Leasing Company)

Present to County Treasurer of lessee’s residence if GVWR is less than 10,000lbs. If the GVWR is 10,000lbs or more, present to the Treasurer of the owner’s residence or, if a nonresident, to the Treasurer where the primary user resides.

Owner:_______________________________________________________________________________________

Iowa DL # or Iowa ID # or Social Security #:___________________________________

First Name

Middle Name

Last Name

(If individual)

Leasing License Number:_______________Birth Date:___________________________

Federal Employer Identification #:________________________________________________

 

 

(If individual)

(If organization)

Bona fide Residence Address of Owner:____________________________________________________________________________________________________________________________________________

 

 

Address

City

County

State

Zip Code

Mailing Address of Owner:____________________________________________________________________________________________________________________________________________________________

 

 

Address

City

County

State

Zip Code

 

 

 

 

 

 

 

 

OWNER INFORMATION (Leasing Company)

 

 

 

Lessee #1:____________________________________________________________________________________

Iowa DL # or Iowa ID # or Social Security :____________________________________

First Name

Middle Name

Last Name

(If individual)

 

 

 

 

Birth Date:________________________________

Federal Employer Identification #:________________________________________________

 

 

(If individual)

(If organization)

 

 

 

Bona fide Residence Address of Lessee #1:__________________________________________________________________________________________________________________________________________

 

 

Address

City

County

State

Zip Code

Mailing Address of Lessee #1:___________________________________________________________________________________________________________________________________________________________

 

 

Address

City

County

State

Zip Code

Lessee #2:____________________________________________________________________________________

Iowa DL # or Iowa ID # or Social Security #:___________________________________

First Name

Middle Name

Last Name

(If individual)

 

 

 

 

Birth Date:________________________________

Federal Employer Identification #:________________________________________________

 

 

(If individual)

(If organization)

 

 

 

Bona fide Residence Address of Lessee #2:__________________________________________________________________________________________________________________________________________

Address

City

County

State

Zip Code

Mailing Address of Lessee #2:___________________________________________________________________________________________________________________________________________________________

Address

City

County

State

Zip Code

VEHICLE INFORMATION

VIN_____________________Year______Make______________________Model______________________Type (car, truck,etc)______________________

Style________________________Color__________________Fuel________ Cylinders______Tonnage_____GVWR_________Sq.Footage_________

Iowa Plate Number (If applicable)_______Validation Number_________________Validation Year____Purchase Date or Date Brought Into State_________________

VIN of traded vehicle (if applicable)_____________________________________________________Trailer Empty Weight (If applicable)

Over 2000lbs

2000lbs or less

 

 

 

SECURITY INTEREST INFORMATION

 

 

Give complete statement of security interests (liens). If none, so state:______________________

 

 

 

 

 

 

 

Nature

Held By

Address (Street, City, State, Zip Code)

 

 

First

 

 

 

 

Security

 

 

 

 

 

 

 

Interest

 

Federal Employer Identification # or Social Security #:

 

 

Second

 

 

 

 

Security

 

 

 

 

 

 

 

Interest

 

Federal Employer Identification # or Social Security #:

 

 

Third

 

 

 

 

Security

 

 

 

 

 

 

 

Interest

 

Federal Employer Identification # or Social Security #:

 

PURCHASE PRICE

Total Lease Price (for motor vehicles with a GVWR less than 16,000, excluding motorcycles and mopeds) $____________

(Check only if applicable)

I claim exemption from payment of the fee for new registration. List Exemption Code_________

(See Page 2)

I claim a business trade exemption for my truck.

I/We certify under penalty of perjury that the foregoing is true and correct*

X_____________________________________________________________________________________________

Signature of OwnerDate

By____________________________________________________________________________________________

If Firm, Association, Corporation, or Attorney in Fact

THE FOLLOWING FOR DEALER USE ONLY: The vehicle dealer named below as “seller” does hereby certify that the new vehicle described above was sold to the applicant for the following consideration which includes freight, manufacturer’s tax, accessories, and other added equipment or services and represents the total delivered price to the purchaser, valued in money whether received in money or otherwise

Sale Price

$________________

Date Registration Applied For Card Issued

Less Trade-In

$________________

If none, so state:____________________

Less charges exempt from fee for new registration

$________________

Registration Fee Collected:____________

Less Rebate applied to purchase price of the vehicle .$________________

 

Equals Fee For New Registration Price

$________________

 

I/We certify under penalty of perjury that the foregoing is true and correct.

_____________________________________________________________________________________________

Date

Dealer No.

Dealership Name

By___________________________________________________________________________________________

 

Authorized Representative

& Title

*Important: Be certain that dates and other information given are correct. Any person who uses a false or fictitious name, makes a false statement or otherwise commits a fraud upon this application is punishable by prison sentence and possible fine. This application also constitutes an application for refund of excess credit, when applicable.

Yes, I would like to make a voluntary contribution to the anatomical gift public awareness and transplantation fund in the amount of $ _________________________

PRIMARY USER INFORMATION (Complete only if the lessee is not the primary user)

Primary User #1:___________________________________________________________________________

Iowa DL # or Iowa ID:______________________________________________________________

First Name

Middle Name

Last Name

(If individual)

 

Birth Date:________________________________

Federal Employer Identification #:________________________________________________

 

 

(If individual)

(If organization)

Bona fide Residence Address of Primary User #1:___________________________________________________________________________________________________________________________________

 

 

Address

City

County

State

Zip Code

Mailing Address of Primary User #1:____________________________________________________________________________________________________________________________________________________

 

 

Address

City

County

State

Zip Code

Primary User #2:___________________________________________________________________________

Iowa DL # or Iowa ID #:_____________________________________________________________

First Name

Middle Name

Last Name

(If individual)

 

 

 

 

Birth Date:________________________________

Federal Employer Identification #:________________________________________________

 

 

(If individual)

(If organization)

 

 

 

Bona fide Residence Address of Primary User #2:___________________________________________________________________________________________________________________________________

Address

City

County

State

Zip Code

Mailing Address of Primary User #2 :____________________________________________________________________________________________________________________________________________________

Address

City

County

State

Zip Code

FEE FOR NEW REGISTRATION - EXEMPTIONS

Owner Name_________________________________________________VIN________________________________________________________

If claiming an exemption from payment of the fee for new registration, check the appropriate box below and complete any required additional information. Any applicable exemption code must be listed above the signature line of this title application form.

UT01 – Transfer by gift, please explain:

UT02 – Purchaser is one of the following non-profit or government organizations:

 

a. Rehabilitation Facility.

b. Rehabilitation Facility for Mentally Retarded Children.

c. Care Facility (residential/intermediate for the Mentally Retarded).

d. Care Facility (residential) for the Mentally ill.

e. Educational Institution (Private, non-profit).

f. Free-standing Hospice Facility.

g. Government.

h. Hospital licensed under Iowa Code Chapter 135B.

i. Community Healthy Center.

j. Migrant Health Center.

k. Community Mental Health Center.

l. Legal Aid Organization.

m. Non-profit Private Museum.

n. Non-profit Art Center.

o. Non-profit Organ Procurement Organization.

 

UT03

 

a. Vehicle transferred from a sole proprietorship or partnership to a corporation or LLC (or vice versa) with the ownership remaining exactly the same and for the purpose of continuing the same business.

b. Corporate Merger – vehicle transferred pursuant to statute to the surviving corporation for no consideration, the merging corporation being dissolved the moment the merger occurs and receiving no benefit from the merger.

Termination date of prior business:Date of creation of new entity:

UT04 - Purchased by a licensed dealership for resale. Dealer License #:

UT05 - Purchased for rental. Purchaser’s sales tax permit #:

UT06 - Leased vehicle used solely in interstate commerce.

UT07 – Vehicle registered and/or operated under Iowa Code Section 326 (reciprocity) with gross weight of 13 tons or more and with 25% of the mileage outside of Iowa. Both weight and mileage must be met to be eligible for exemption.

UT08 - Other:

 

 

a. Manufactured housing or mobile Home.

 

b. Inheritance or court order (e.g.: divorce).

c. Vehicle Purchased outside Iowa with no intent to use in Iowa. (A “move-in”)

d. Homemade vehicle.

e. Sales, Use, or Occupational tax paid to another state at time of purchase.

f. Name dropped.

g. Name added.

 

h. Even trade or down trade.

i. Delivered to a resident Native American Indian on the reservation.

j. In-Transit title, fee to be paid in title-holder’s state of residence.

k. Transfer to or from a living or irrevocable trust.

l. Other, please explain_________________________________

s. Salvage vehicle.

 

 

 

 

 
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Document Attributes

Fact Name Description
Purpose of Form The Iowa 411179 form is used to apply for a certificate of title and/or registration for a leased vehicle in the state of Iowa.
Governing Law This form is governed by Iowa Code Chapter 321, which outlines vehicle registration and titling requirements.
Owner Information When completing the form, you must provide detailed information about both the owner and the lessee, including names, addresses, and identification numbers.
Security Interests The form requires you to disclose any security interests or liens on the vehicle. If there are none, you can simply state that.
Exemptions There are specific exemptions available for registration fees. You can claim these if you meet the criteria outlined in the form.
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