Keep with the vehicle at all times.
Temporary Tag Number_________________________
Owner First Name_________________________
Type of Plate: _________________________________
Owner Middle Name_______________________
VIN:_________________________________________
Owner Last Name_________________________
Vehicle Make:_________________________________
Business Name:___________________________
Vehicle Body Style:_____________________________
Owner DL Number:________________________
Vehicle Model:________________________________
Owner DL State:___________________________
Weight:______________________________________
Owner Address:___________________________
Vehicle Color Body: ____________________________
Owner City:______________________________
Vehicle Color Top:______________________________
Owner Parish:____________________________
Vehicle Model Year:____________________________
Owner State:_____________________________
Date Acquired:________________________________
Owner Zip:_______________________________
Tax/Delivery Date:_____________________________
Email:___________________________________
Temp Tag Expiration:___________________________
Second Owner Business Name:_______________
Electronic Fund Transfer Code:___________________
Second Owner First Name:__________________
Electronic lien Transfer Code:_____________________
Second Owner Middle Name:________________
Dln/Ein of Renter:______________________________
Second Owner Last Name:___________________
Trade VIN:____________________________________
Business Name 2:__________________________
Trade License Number:__________________________
Second Owner DLN:________________________
First Lienholder Name:__________________________
Second Owner DL State:____________________
First Lienholder Address:________________________
Second Owner Email:_______________________
First Lienholder City:____________________________
Renewal Mailed to Owner:__________________
First Lienholder State:___________________________
Second Address Type:______________________
First Lienholder Zip:____________________________
Second First Name:________________________
Second Lienholder Name:________________________
Second Middle Name:______________________
Second Lienholder Address:______________________
Second Last Name:________________________
Second Lienholder City:_________________________
Second Address:___________________________
Second Lienholder State:________________________
Second City:______________________________
Second Lienholder Zip:__________________________
Second Parish:____________________________
New or Used:_________________________________
Second State:_____________________________
Previous Title Number:__________________________
Second Zip:_______________________________
Previous Title State:____________________________
Cost of Vehicle:___________________________
Within Municipality:____________________________
Less Trade:_______________________________
Special Tax Area:_______________________________
Rebate:__________________________________
Special Tax District:_____________________________
Tax Value:________________________________
Dealer Name:_________________________________
Act of Donation:___________________________
Dealer Collect Tax:_____________________________
Act of Donation Relationship:________________
Dealer License Number:_________________________
Tax Exempt:______________________________
Tax Exempt Code:_________________________
Entry Date:_______________________________