Application For Replacement Title Page 2
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4Keep in your vehicle until registration card is received.
DMV
Notice of Transaction
Submitted
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
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
MEMORANDUM RECEIPT #
DEALER TRANS
PRE CHECKER
TITLE FEE
$
Complete Lines 1 through 1. The ownership information must reflect what is currently shown on DMV records.
PRESENT OREGON PLATE #
YEAR
MAKE
STYLE
VEHICLE IDENTIFICATION NUMBER (VIN)
TITLE NUMBER
1
EQUIPMENT #
REG WEIGHT / LENGTH
PLUG-IN
FLEX-FUEL
GVWR OVER
DIESEL
HYBRID
YES
GAS
HYBRID
2
26,000 LBS.
NATURAL
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:
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:
OF JOINT OWNER OR LESSEE
6
PRINT FULL LEGAL NAME:
OF JOINT OWNER OR LESSEE
7
ONE-TIME MAILING ADDRESS (For this transaction only - address will not show on your customer record)
Reg. Only
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
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Parent category: Legal