Form Reg 343 - Application For Appointment As Notary Public Page 2

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must complete vehicle inFormation below:
VEHICLE IDENTIFICATION NUMBER
VEHICLE MAKE
YEAR MODEL
SECTION 5 — DATE INFORMATION
If vehicle was previously registered in CA, then registered or located
DATE VEHICLE ENTERED OR WILL ENTER CALIFORNIA (CA):
out-of-state and has now returned to CA, enter most recent date vehicle
Month
Day
Year
entered CA. If you did not own vehicle at time of entry, check this box:
Or enter date vehicle will be operated, if it has not been operated
DATE VEHICLE FIRST OPERATED IN CALIFORNIA:
Month
Day
Year
yet.
Enter the date whichever occurred first. If you have been a resident
DATE YOU WENT TO WORK IN CALIFORNIA, OBTAINED A CA DRIVER LICENSE, OR BECAME A RESIDENT:
since birth, enter date of birth. If you are not a CA resident, check
Month
Day
Year
this box:
DATE VEHICLE WAS PURCHASED OR ACQUIRED:
AND WAS (CHECK BOX):
AND WAS PURCHASED (CHECK BOX):
Month
Day
Year
New
Used
Inside CA
Outside CA
SECTION 6 — COST INFORMATION
NOTE: The total cost or value of the vehicle must include the cost of the basic vehicle, value of any trade-in, and all accessories and leased
equipment permanently attached. Cost does not include sales tax, insurance, finance charges, or warranty.
MuST CHECk ONE bOx ONLY, AND ENTER REquIRED INFORMATION FOR THAT ONE bOx:
VEHICLE WAS PURCHASED OR ACQUIRED FROM:
PURCHASE – I purchased the vehicle for the price of $
Dealer
Private Party
Dismantler
.
GIFT – I acquired the vehicle as a gift. Its current market value is $
Immediate Family Member – State
.
A Statement of Facts (REG 256) form must be completed.
Relationship:
TRADE – I acquired the vehicle as a trade. Its value when I acquired it was $
.
FOR ALL VEHICLES:
Since purchasing or acquiring this vehicle, were any body type modifications, additions and/or alterations (e.g., changing from pickup to utility,
etc.) made to this vehicle? If yes, a Statement of Construction (REG 5036) form must be completed. ......................................
Yes
No
FOR REVIVED JUNK OR REVIVED SALVAGE VEHICLES:
The cost of the vehicle must include the labor cost, whether or not the labor was provided or done by you. The total cost of the vehicle including
labor is $
.
SECTION 7 — FOR OuT-OF-STATE OR OuT-OF-COuNTRY VEHICLES
For vehicles which enter the state within 1 year of purchase, was Sales Tax paid to another state? ............................
N/A
Yes
No
If yes, enter amount of tax paid $
(this amount will be credited toward any Use Tax in CA). If your vehicle was last
registered in another state, you may be eligible for a Use Tax exemption. For more information, contact the Board of Equalization ( ).
For commercial vehicles (including pickups), this vehicle was last registered as a:
Commercial Vehicle
Non-commercial Automobile in
the last state of registration.
DISPOSITION OF OUT-OF-STATE PLATES:
The plates will not be affixed to any vehicle at any time, unless the vehicle is “Dual Registered” in both states. The plates are:
Expired, or will be or were:
Surrendered to CA DMV
Destroyed
Retained
Returned to the motor vehicle department of the state of issuance.
SECTION 8 — MILITARY SERVICE INFORMATION
Are you or your spouse on active duty as a member of the U.S. Uniformed Services? ...............................................................
Yes
No
If yes, you may qualify for an exemption. Refer to Nonresident Military Exemption (REG 5045) form.
When this vehicle was last licensed, were you or your spouse on active duty as a member of the U.S. Uniformed Services? ...
Yes
No
If yes, in what state or country were you or your spouse stationed?
SECTION 9 — CERTIFICATIONS signatures required.
The signature for a company or business MUST include the printed name of the company/business and an authorized representative’s
countersignature on the signature line (e.g., ABC CO. by JOHN SMITH or JOHN SMITH for ABC CO.).
The registered owner mailing address is valid, existing, and an accurate mailing address. I consent to receive service of process at this mailing
address pursuant to CVC §1808.21.
i certify (or declare) under penalty of perjury under the laws of the state of california that the foregoing is true and correct.
PRINTED NAME
OWNER’S SIGNATURE
DATE
DAYTIME TELEPHONE NUMBER
x
(
)
PRINTED NAME
CO-OWNER’S SIGNATURE
DATE
DAYTIME TELEPHONE NUMBER
x
(
)
PRINTED NAME
CO-OWNER’S SIGNATURE
DATE
DAYTIME TELEPHONE NUMBER
x
(
)
REG 343 (REV. 2/2012) WWW
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