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VEHICLE TRANSACTION APPLICATION

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STATE OF ALASKA DIVISION OF MOTOR VEHICLES VEHICLE TRANSACTION APPLICATION Form 812 (Rev. 07/2017) 812APPLICATION TYPE TITLE CHANGE OF OWNERSHIP REPLACEMENT TITLE CORRECTION / ADD OR REMOVE LIENHOLDER REGISTRATION REGISTRATION LOST TAB LOST PLATE OTHER _______________ I AM ALSO APPLYING FOR AN EXEMPTION: SENIOR (65+) MILITARY GUARD DISABILITY CHARITABLE/GOVERNMENT PERMANENT REGISTRATION (I LIVE IN AN ELIGIBLE AREA) OTHER ________________ VEHICLE INFORMATION SERIAL NUMBER (VIN) SECONDARY SERIAL NUMBER (VIN) YEAR MAKE MODEL BODY STYLE COLOR ODOMETER (MILES) WEIGHT ACTUAL ESTIMATED IS VEHICLE USED COMMERCIALLY YES NO AK LICENSE PLATE # NEW PLATES REQUESTED OWNER INFORMATION FULL FIRST NAME FULL MIDDLE NAME FULL LAST NAME SUFFIX DRIVER LICENSE # STATE DATE OF BIRTH ORGAN DONOR YES NO SOCIAL SECURITY NO. COMPANY OR TRUST NAME (If applicable) TAXPAYER ID NO. Are you an Alaska Resident?

BIENNIAL Heavy Vehicle Use Tax Declaration IRS 2290 ATTACHED EXEMPT DOT NO. NO. OF AXLES IS THE CARRIER RESPONSIBLE FOR SAFE OPERATION

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