Application For Replacement Title
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DMV
Application for Replacement Title
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
If there are ANY changes in ownership, and if renewing registration, you must complete an Application for
Title and Registration (Form 735-226) in addition to this form. Please read the instructions on the back of
this form carefully before completing this application.
TRANS CODE
VT
TI
MP
PROCESS
EX
MISC
BATCH CODE
5
DEALER TRANS
MEMORANDUM RECEIPT #
PRE CHECKER
TITLE FEE
$
Complete Lines 1 through 18. The ownership information must reflect what is currently shown on DMV records.
YEAR
STYLE
PRESENT OREGON PLATE #
MAKE
VEHICLE IDENTIFICATION NUMBER (VIN)
TITLE NUMBER
1
PLUG-IN
EQUIPMENT #
REG WEIGHT / LENGTH
FLEX-FUEL
GVWR OVER
GAS
DIESEL
HYBRID
YES
HYBRID
2
NATURAL
26,000 LBS.
OTHER:
ELECTRIC
PROPANE
NO
GAS
List additional owners on Lines 6 and 7. (This in no way determines a priority of ownership.)
If any owner listed uses a work address on DMV records, that owner must be shown on Line 3.
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF (check one)
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
OWNER
OR
LESSEE
3
RESIDENCE ADDRESS - (If owner is a business, use business address)
MAILING ADDRESS - (If different from residence)
4
CITY, STATE, ZIP CODE
COUNTY OF RESIDENCE
CITY, STATE, ZIP CODE
COUNTY OF MAILING
5
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF JOINT OWNER OR LESSEE
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
6
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF JOINT OWNER OR LESSEE
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
7
Reg. Only
ONE-TIME MAILING ADDRESS (For this transaction only - address will not show on your customer record)
VEHICLE ADDRESS - (Location of vehicle if different from residence)
8
Title Only
Both
CITY, STATE, ZIP CODE
COUNTY (of vehicle address or use)
CITY, STATE, ZIP CODE
9
SECURITY INTEREST HOLDER (Bank, Finance Company, Person, etc.)
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
10
SECURITY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE
TELEPHONE #
11
(
)
SECONDARY INTEREST HOLDER (Bank, Finance Company, Person, etc.)
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
12
SECONDARY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE
TELEPHONE #
13
(
)
LESSOR (Complete only if lessee is shown as owner on Line 3 above)
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
14
LESSOR ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE
TELEPHONE #
15
(
)
The owner must certify by completing all applicable statements and sign the application to apply for title and registration in Oregon. Under
Oregon law, it is a crime to knowingly make any false statement on an application for title or registration (ORS 803.070 / ORS 803.385). Both
offenses are Class A misdemeanors and are punishable by a jail sentence of up to one year, a fine of up to $6,250 or both.
I hereby request a replacement title and certify to the best of my knowledge the title for this vehicle has been lost, destroyed or mutilated, and
to the best of my knowledge has not been signed, conveyed or transferred to another party. (If mutilated, the title or what remains of the title is
attached.) If I, as the title holder on DMV records, cannot certify what happened to the title, the additional signature of the person who has this
knowledge appears on Line 18.
PLEASE NOTE: SIGNATURES ON THIS FORM DO NOT RELEASE INTEREST.
TELEPHONE #
SIGNATURE OF OWNER, SECURITY INTEREST HOLDER OR LESSOR
DATE
(
)
16
X
TELEPHONE #
(
)
TELEPHONE #
SIGNATURE OF OWNER, SECURITY INTEREST HOLDER OR LESSOR
DATE
(
)
17
X
TELEPHONE #
(
)
SIGNATURE OF PERSON CERTIFYING THE TITLE IS LOST, DESTROYED, OR MUTILATED, IF NOT AN OWNER SHOWN ON DMV RECORDS.
SIGNATURE
DATE
COUNTER DATE STAMP / INITIALS
18
X
735-515 (1-18)
STK# 300164
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