Fillable Dmv Application For Title And Registration printable pdf download

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DMV

Application for

Clear Form

Title and Registration

TITLE FEE

DRIVER AND MOTOR VEHICLE SERVICES

1905 LANA AVE NE, SALEM OREGON 97314

REG / REN FEE

PLATE CODE

TRANS CODE

ORG

PROCESS

MISC

TITLE BRAND

VIN FEE

PERMIT #

MEMORANDUM RECEIPT #

DEALER TRANS

PRE CHECKER

VIN INSPECTION:

DATE / INITIALS:

LATE TITLE FEE

LEV COMPLIANT:

YES

NEW PLATE #

STICKER #

VEHICLE IDENTIFICATION NUMBER (VIN)

OREGON TITLE #

REPLACEMENT FEE

PRESENT OREGON PLATE #

EXPIRATION DATE

YEAR

MAKE

STYLE

REG WEIGHT / LENGTH

GVWR OVER

YES

PLATE TRANSFER

26,000 LBS.

FARM ID #

FLEET ACCOUNT #

EQUIPMENT #

DIESEL

HYBRID

GAS

TRAILER OVER

TOTAL FEE

YES

8,000 LBS.

ELECTRIC

PROPANE

OTHER:

ODOMETER:

Federal and State laws require that you state the mileage when you transfer ownership. Failure to complete an odometer disclosure or providing a false statement may result in fines and/or

imprisonment. Under Oregon law, the offense for submitting a false odometer disclosure is a Class C felony (ORS 815.430). Use this odometer certification for motor vehicles 9 years old or newer and when

you are unable to obtain the proper disclosure from the seller. I certify the odometer disclosure listed is true and correct. A disclosure is not available on the required form from the seller. I agree to hold DMV

harmless for any action resulting from my not submitting the seller's disclosure.

DATE OF READING (MM/DD/YYYY)

ODOMETER READING (NO TENTHS)

I certify that, to the best of my knowledge, the odometer reading is actual

mileage UNLESS one of these boxes is marked:

the mileage stated is in excess of its mechanical limits (has rolled over); or

the odometer reading is NOT actual mileage. WARNING - odometer discrepancy.

Complete Line 5 with the owner whose address will be used for all DMV mail regarding this vehicle. List additional owners on Lines 8 and 9. (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 5. See reverse for more

information.

LAST, FIRST, MIDDLE OF (check one)

ODL / ID / CUSTOMER #

DATE OF BIRTH (MM/DD/YYYY)

OWNER

LESSEE

RESIDENCE / BUSINESS ADDRESS - (Address will be used to update your ODL / ID card)

MAILING ADDRESS (If different from residence – will be used to update your ODL / ID card)

CITY, STATE, ZIP CODE

COUNTY OF RESIDENCE

CITY, STATE, ZIP CODE

COUNTY OF MAILING

LAST, FIRST, MIDDLE (See "Change of Address" on reverse)

ODL / ID / CUSTOMER #

DATE OF BIRTH (MM/DD/YYYY)

ODL / ID / CUSTOMER #

DATE OF BIRTH (MM/DD/YYYY)

LAST, FIRST, MIDDLE (See "Change of Address" on reverse)

Reg. Only

ONE-TIME MAILING ADDRESS (Will not change your customer record)

VEHICLE ADDRESS - (Location of vehicle if different from residence)

Title Only

Both

COUNTY (of vehicle address or use)

CITY, STATE, ZIP CODE

SURVIVORSHIP:

Joint Owners or Lessees agree that title will show joint ownership with right of survivorship.

YES

Joint Security Interest Holders agree that title will show joint security interest with right of survivorship.

YES

SECURITY INTEREST HOLDER (Bank, Finance Company, Person, etc.)

ODL / ID / CUSTOMER #

DATE OF BIRTH (MM/DD/YYYY)

SECURITY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE

TELEPHONE #

(

)

SECONDARY INTEREST HOLDER (Bank, Finance Company, Person, etc.)

ODL / ID / CUSTOMER #

DATE OF BIRTH (MM/DD/YYYY)

SECONDARY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE

TELEPHONE #

(

)

LESSOR (Complete only if lessee is shown as owner on Line 5 above)

ODL / ID / CUSTOMER #

DATE OF BIRTH (MM/DD/YYYY)

LESSOR ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE

TELEPHONE #

(

)

The owner must certify by completing all applicable statements and sign the application to apply for title and registration in Oregon. By signing this application, I also acknowledge the survivorship

as indicated above. Under Oregon law, it is a crime to knowingly make any false statement on an application for title or registration (ORS 803.070, 803.075, 803.375 and 803.385). These offenses are

Class A misdemeanors and are punishable by a jail sentence of up to one year, a fine of up to $6, 50 or both.

INSURANCE:

I certify to one of the following: 1) If this application includes registration, and this motor vehicle is subject to financial responsibility laws, I am in compliance and will remain in compliance until

the vehicle is transferred; or 2) If this application includes a registration renewal for a motor vehicle, this vehicle is covered by the motor vehicle liability insurance policy listed below.

INSURANCE COMPANY (Not agent)

POLICY #

DOMICILE / RESIDENCY: My place of domicile (home) is in Oregon, or I am otherwise eligible or required to register the vehicle under Oregon law (ORS 803.200, 803.350 and 803.360).

VEHICLE USE: If the ownership of this vehicle has not been transferred and the registration is being renewed on a tow/recovery, farm, manufactured structure toter, or charitable/non-profit vehicle, I certify the vehicle still qualifies for special registration and

the use still conforms to the law as previously certified. I certify that my special use trailer, if over eight and one-half feet in width, is used temporarily on a construction site for office purposes only.

(

)

SIGNATURE OF OWNER OR LESSEE AS SHOWN ABOVE

DATE

HOME PHONE #

MESSAGE PHONE #

(

)

SIGNATURE OF LESSOR (Required if security interest holder is different than lessor)

DATE

COUNTER DATE STAMP / INITIALS

735-226 (