Form 07-012 - Request To Transfer Driver/change Information
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State of Oregon
DAS Fleet & Parking Services
Request to Transfer Driver/Change Information - Form 07-012
Long-term or Seasonal
Requested By
Agency Name
Date of Request
Division or Unit
Six-digit Agency Number
Effective Date
Please specify purpose of request
(If your request pertains to more than 1 vehicle, list all vehicle license plate numbers in section B)
Transfer assignment of vehicle license # _______________ to another driver/agency contact
(fill out sections A and D)
This vehicle transfer is to increase miles driven on an underutilized vehicle
Change cost center for vehicle license # _______________ from _________________________ to __________________________
(fill out section D)
Change agency number for vehicle license # _______________ from _________________ to __________________
(fill out sections A and D)
Change address of current driver/agency contact for vehicle license # _______________
(fill out sections A and D)
Change phone number of current driver/agency contact for vehicle license # _______________
(fill out sections A and D)
Driver's License # - ONLY ENTER LAST 4 DIGITS
State
Driver/Agency Contact Name (last name, first name) - VEHICLE WILL BE/IS ASSIGNED TO THIS PERSON
City
State
ZIP
Driver/Agency Contact Office Mailing Address
A
Driver/Agency Contact Office Physical Address (if different from above) City
State
ZIP
MOBILE Phone Number
E-mail - ALL CORRESPONDENCE WILL BE SENT TO THIS ADDRESS
Office Phone Number
If your request pertains to more than 1 vehicle, list all vehicle license plate numbers below.
Please note if this vehicle transfer is to increase miles driven on an underutilized vehicle.
B
Additional Information
C
REQUESTING AGENCY APPROVAL
Type or Print Name
Title
Signature
D
MOTOR POOL USE ONLY
Date to Pending
DEQ
Transfer Date
Manager Approval
Y
N
Send to: DAS Fleet & Parking Services, 1100 Airport Rd SE, Salem, OR 97301-6082
07-012
Rev. 9/24/2014
Phone: (503) 378-4377
Fax: (503) 378-5813
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Parent category: Legal