Form Reg 227 - Application For Duplicate Or Paperless Title

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APPLICATION FOR:
A Public Service Agency
Duplicate Title
(Complete Parts 1 through 3)
Paperless Title Certifi cation
(Complete Parts 1 through 3)
Transfer of Title With Duplicate Title
(Seller completes Parts 1 through 5, Buyer completes Parts 6 through 10, as needed.)
Transfer of Title With Paperless Title
(Seller completes Parts 1 through 5, Buyer completes Parts 6 through 10, as needed.)
LICENSE PLATE/CF NUMBER
VEHICLE/VESSEL ID NUMBER
YEAR/MAKE
1. REGISTERED OWNER(S) OF RECORD
TRUE FULL NAME (LAST, FIRST, MIDDLE)
TRUE FULL NAME (LAST, FIRST, MIDDLE)
RESIDENCE OR BUSINESS ADDRESS
APT./SPACE NUMBER
CITY
STATE
ZIP CODE
DRIVER LICENSE/ID CARD NUMBER
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
APT./SPACE NUMBER
CITY
STATE
ZIP CODE
DRIVER LICENSE/ID CARD NUMBER
2. LEGAL OWNER OF RECORD (TITLE HOLDER)—Do not enter name of owners above
NAME OF FIRM OR INDIVIDUAL HAVING A LIEN ON THIS VEHICLE
ADDRESS
APT./SPACE NUMBER
CITY
STATE
ZIP CODE
3. MISSING TITLE STATEMENT—WARNING: Issuance of a duplicate title cancels the original title.
The Certifi cate of Title issued for this vehicle/vessel is:
Lost
Stolen
Not received
Illegible/Mutilated (attach old title)
Paperless Title
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
I agree to indemnify and save harmless the Director of Motor Vehicles for any loss suffered resulting from the issuance of said
duplicate certifi cate of title.
SIGNATURE
DATE
DAYTIME TELEPHONE NUMBER
X
PRINTED NAME OF OWNER/AGENT SIGNING FOR COMPANY
PRINTED NAME OF LEGAL OWNER
4. REGISTERED OWNER(S) RELEASE OF OWNERSHIP AND/OR INTEREST
I/we release interest in the described vehicle/vessel.
SIGNATURE OF OWNER
DATE
DAYTIME TELEPHONE NUMBER
X
SIGNATURE OF OWNER
DATE
DAYTIME TELEPHONE NUMBER
X
5. LEGAL OWNER OF RECORD RELEASE OF OWNERSHIP AND/OR INTEREST—Signature must be notarized.
The undersigned lienholder (legal owner of record) certifi es release of interest in the vehicle/vessel.
SIGNATURE OF LEGAL OWNER (COMPANY NAME MUST BE COUNTERSIGNED)
PRINTED NAME OF AGENT SIGNING FOR COMPANY
DATE
X
State of California
)
County of
)
On ___________________________ before me, ____________________________________________________________________
personally appeared __________________________________________________________________________________________
___________________________________________________________________________________________________________
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/
her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and offi cial seal.
Signature __________________________________
(Seal)
REG 227 (REV. 2/2007) WWW

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