Form Tsgi0032 - Declaration Of Non-Ownership (Or Lease/rental) printable pdf download

CITY OF LOS ANGELES

CALIFORNIA

PARKING VIOLATIONS BUREAU

PAYMENTS

P.O. BOX 30420

LOS ANGELES, CA 90030

(866) 561-9742

TTY8AM - 5PM

(213) 523-7046

DECLARATION OF NON-OWNERSHIP (OR LEASE/RENTAL)

INSTRUCTIONS: You are charged with the violation(s) described on your ticket(s). Under Calif. Vehicle Code, Section 40200 it is presumed that the registered owner

of the vehicle was the person who parked it illegally. You were listed at the DMV as the registered owner on the date of the violation(s). If you did not own the vehicle on

that date, complete the declaration below and return it to the following address: PVB Correspondence - P.O. Box 30420 - Los Angeles, CA 90030.

Please do not leave any blank spaces on the form. Doing so may delay processing of your claim. In addition, one of the following required documentation must be

submitted along with the form below, as may be applicable to your claim. Please check one of the following:

Sold to someone else - Please submit ONE of the following:

A copy of the Notice of Transfer and Release of Liability form that was filed with the DMV at the time of sale/transfer of the vehicle; OR

Bill of Sale/Trade-in agreement from a licensed car dealer or leasing company (Proof of private party sales are NOT accepted); OR

A copy of an IRS approved vehicle donation document from a charity.

Leased/rented under a written agreement - Please submit the following:

A copy of rental or lease agreement - Proof of written lease or rental agreement which includes the name, address, and driver’s license number of the person to

whom the vehicle is leased or rented must be submitted within 30 days of the “Notice Date”.

Name and address of Responsible Party: (PLEASE PRINT LEGIBLY)

Name __________________________________________________________________________________________________________________________________________

Street __________________________________________________________________________________________________________________________________________

City/State/Zip Code _______________________________________________________________________________________________________________________________

Date of sale, purchase, or lease/rental was executed (MM/DD/YYYY) ___ ___ / ___ ___ / ___ ___ ___ ___

License Plate Number ___________________________________________

FULL 16-DIGIT VIN: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

I declare under penalty of perjury that the foregoing is true and correct.

_____________________________________________________________

____________________________________

(Signature)

(Date)

*NOTE: If all information for the declaration of non-ownership is not accurately completed and verified by the DMV, the declaration will be disregarded and you will be

responsible for clearing the violation.

TSGI0032 - Rev. 06/2016

Form Tsgi0032 - Declaration Of Non-Ownership (Or Lease/rental)

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