Form Reg 256 - Miscellaneous Statements Of Fact
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1
2MISCELLANEOUS STATEMENTS OF FACT
Complete the appropriate section(s) and sign Section K.
A Public Service Agency
LICENSE PLATE/CF NUMBER
VEHICLE/VESSEL ID NUMBER
YEAR/MAKE
A.
USE TAX EXEMPTION STATEMENT
This vehicle/vessel is being transferred because of:
Family transfer (received from parent [does not include in-laws], child, grandparent, grandchild, spouse, siblings if both
minors related by blood or adoption).
Note: The exemption cannot be claimed if the seller is engaged in the business of selling the type of vehicle being
transferred.
Addition or deletion of family member (spouse, parent(s), son/daughter, grandparents, grandchildren).
Gift (does not include vehicles traded between individuals, transfer of contracts or other valuable consideration).
Court Order
Inheritance
The current market value is: $________________ (not required if received from family member.)
B.
SMOG EXEMPTION STATEMENT
The vehicle does not require a smog certification for transfer of ownership because:
The last smog certification was obtained within the last 90 days.
It is powered by:
electricity
diesel
Other ___________________________.
It is located outside the State of California. (Exception: Nevada and Mexico)
It is being transferred from/between:
The parent, grandparent, child, grandchild, brother, sister, or spouse of the transferee.*
A sole proprietorship to the proprietor as owner.*
Companies whose principal business is leasing vehicles. There is no change in lessee or operator.*
Lessor and lessee of vehicle, and no change in the lessee or operator of the vehicle.*
The lessor and person who has been lessee’s operator of the vehicle for at least one year.*
Individual(s) being added as registered owner(s).*
* Does not require Smog Certification unless Biennial Smog is required.
C.
TRANSFER ONLY OR TITLE ONLY STATEMENT
This vehicle has not been used or parked on a street or highway or off-highway. I am applying for a:
Transfer Only
Title Only
The vehicle is not currently registered. It has not been driven, moved, towed, or left standing on any California public highway
to cause registration fees to become due. It was not transported over any California public highway or operated within
California to cause off-highway fees to become due. Appropriate registration will be obtained before the vehicle is operated.
D.
VEHICLE CONSTRUCTION STATEMENT
This vehicle/vessel was constructed
by me
for me by ___________________________________________ and
accompanying this application are bills of sale for the following component parts:
Engine ___________________________________________
Transmission
Frame
Body
YEAR MODEL
MAKE
Please explain how you acquired the component parts listed above and why you are unable to provide proof of purchase or
trade value (bill of sale, invoice, etc.) for those parts.
TOTAL VALUE OF VEHICLE (INCLUDING LABOR) $________________ .
This vehicle is free and clear of all liens and encumbrances (debts) except as shown on the application form.
E.
VEHICLE BODY CHANGE STATEMENT
The current market value of the vehicle or vessel is: $________________ .
Changes were made at a cost of $________________ on this date ________________ .
This is what I changed: Check all that apply:
Unladen Weight changed because _______________________________ (Public Weigh Master Certificate is required.
Motive Power changed from ________________ to ________________ . Exception: Trailers)
Body Type changed from ________________ to ________________ .
Number of Axles changed from ________________ to________________ .
(Continued on reverse side)
REG 256 (REV. 1/2003) WWW
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