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DMV USE ONLY - oregon.gov

735-268 ( -1 )STK# 300111 PLATE TRANSFER FEEA pplication for Registration,Renewal, Replacement or Transfer of Platesand/or StickersCOUNTER DATE STAMP / INITIALSSIGNATURE OF OWNER AS SHOWN ABOVESIGNATURE OF JOINT OWNER AS SHOWN ABOVEDATEDATET ransaction Type:Disposition of Plates 2EG #ARDOR 3 TICKERS:XX1 1 1 SURRENDEREDLOSTMUTILATEDSTOLENThis application cannot be used to change or correct the name(s) shown on the title or to change :PERMIT #HVUTMISCEXPIRATION DATENEW PLATE #STICKER #YEARMAKESTYLEFLEET ACCOUNT #FARM ID #WEIGHT / LENGTHEQUIPMENT #PRESENT oregon PLATE #VEHICLE IDENTIFICATION NUMBER (VIN) oregon TITLE #SPECIAL PLATESREPLACEMENT FEETOTAL FEE PAIDBATCH CODEREG / REN FEETRANS CODEVT%QORNGVG.

JOINT OWNER OR LESSEE - PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE (See “Change of Address” on reverse) JOINT OWNER OR LESSEE - PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE (See “Change of Address” on reverse) RESIDENCE / BUSINESS ADDRESS - (Address will be used to update your ODL / ID Card)

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Transcription of DMV USE ONLY - oregon.gov

1 735-268 ( -1 )STK# 300111 PLATE TRANSFER FEEA pplication for Registration,Renewal, Replacement or Transfer of Platesand/or StickersCOUNTER DATE STAMP / INITIALSSIGNATURE OF OWNER AS SHOWN ABOVESIGNATURE OF JOINT OWNER AS SHOWN ABOVEDATEDATET ransaction Type:Disposition of Plates 2EG #ARDOR 3 TICKERS:XX1 1 1 SURRENDEREDLOSTMUTILATEDSTOLENThis application cannot be used to change or correct the name(s) shown on the title or to change :PERMIT #HVUTMISCEXPIRATION DATENEW PLATE #STICKER #YEARMAKESTYLEFLEET ACCOUNT #FARM ID #WEIGHT / LENGTHEQUIPMENT #PRESENT oregon PLATE #VEHICLE IDENTIFICATION NUMBER (VIN) oregon TITLE #SPECIAL PLATESREPLACEMENT FEETOTAL FEE PAIDBATCH CODEREG / REN FEETRANS CODEVT%QORNGVG.

2 KPG YKVJ VJG QYPGT YJQUG CFFTGUU YKNN DG WUGF HQT CNN &/8 OCKN TGICTFKPI VJKU XGJKENG .KUV CFFKVKQPCN QYPGTU QP .KPGU CPF 6 JKU KP PQ YC[ FGVGTOKPGU C RTKQTKV[ QH QYPGTUJKR +H CP[ QYPGT NKUVGF WUGU CP CIGPE[ CFFTGUU QP &/8 TGEQTFU VJCV QYPGT OWUV DG UJQYP QP .KPG 5GG TGXGTUG HQT OQTG KPHQTOCVKQP 231 JOINT OWNER OR lessee - PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE (See Change of Address on reverse) ONE-TIME MAILING ADDRESS (For this transaction only address will not show on your customer record)CITY, STATE, ZIP CODEDATE OF BIRTHDATE OF BIRTHODL / ID / CUSTOMER #DATE OF BIRTHPRINT FULL LEGAL NAME.]]]]

3 LAST, FIRST, MIDDLE OF (check one)RESIDENCE / BUSINESS ADDRESS - (Address will be used to update your ODL / ID Card)MAILING ADDRESS - (If different from residence)CITY, STATE, ZIP CODECOUNTY OF RESIDENCECOUNTY OF MAILINGJOINT OWNER OR lessee - PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE (See Change of Address on reverse) OWNERORLESSEECITY, STATE, ZIP CODEODL / ID / CUSTOMER #ODL / ID / CUSTOMER #VEHICLE ADDRESS - (Location of vehicle if different from residence)COUNTY (of vehicle address or use)CITY, STATE, ZIP CODE78910564 DEPARTMENT OF TRANSPORTATIONDRIVER AND MOTOR VEHICLE SERVICES1905 LANA AVE NE, SALEM oregon 97314 DMVP late Type:GROUPTREEREMARKS:REGISTRATION / RENEWALREPLACE PLATE(S)REPLACE STICKER(S)REPLACE REG.

4 CARDEXPLATE CODEMPBy signing this application, I certify that:My home is in oregon or I am otherwise eligible or required to register this vehicle under oregon law. (Proof may be required if the department has reason to believe you are not domiciled in oregon . ORS , ORS , ORS ).1)If this application includes registration, and this motor vehicle is subject to the financial responsibility laws, I am in compliance and willremain in compliance until the vehicle is transferred; or 2) If this application includes a registration renewal, this vehicle is covered by themotor vehicle liability insurance policy listed COMPANY (not agent)

5 POLICY #1 If I am a company required by federal law to participate in a drug and alcohol testing program, then I certify that I have an in-house program that meets federal requirements, or that I am a member of a consortium that provides testing that meets federal requirements, or that I am exempt from this requirement by federal the vehicle is registered as tow/recovery, farm, manufactured structure toter, or charitable/non-profit, the vehicle still qualifies for special registration and the use still conforms to the law as previously information provided on the front and back of this application is true and correct to the best of my knowledge.

6 I understand it is a crime under ORS , to certify the truth of a statement when I know the statement is not true. This offense is a Class A misdemeanor and is punishable by a jail sentence of up to one year, a fine of up to $6,250, or NAME(s) OF PERSON(s) OPERATING THE CONSORTIUM zzzzzzIf this is a commercial vehicle, I am knowledgeable of the applicable federal motor carrier safety regulations and hazardous materialsregulations or compatible state :DIESELHYBRIDPLUG-INNATURALHYBRIDWINE COUNTRYCURRENT OR PREVIOUS MILITARY 5 ERVICE: + RTKPV PCOG AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAA CWVJQTK\G &/8 VQ UGPF O[ PCOG CPF CFFTGUU to the oregon Department of Veterans' Affairs (ODVA) for the purpose of receiving benefit information.]

7 (Signature) : AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAA11&,%8 &5%,4%,%PHONE #4%,%PHONE #( CUSTOMSALMON OTHER: ?????????????????????????????#2!4%2 ,!+%42!), ",!:%23 CULTURALVEHICLEINFORMATIONDMV USE ONLYOWNERor lessee / ADDRESSCERTIFICATIONSSIGNATURESADDITIONA LINFORMATIONJOINT OWNER OR lessee - PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE (See Change of Address on reverse) JOINT OWNER OR lessee - PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE (See Change of Address on reverse) RESIDENCE / BUSINESS ADDRESS - (Address will be used to update your ODL / ID Card)Notice of TransactionSubmittedREMARKS.

8 PERMIT #HVUTMISCEXPIRATION DATENEW PLATE #STICKER #YEARMAKESTYLEFLEET ACCOUNT #FARM ID #WEIGHT / LENGTHEQUIPMENT #PRESENT oregon PLATE #VEHICLE IDENTIFICATION NUMBER (VIN) oregon TITLE #SPECIAL PLATESREPLACEMENT FEETOTAL FEE PAIDBATCH CODEREG / REN FEETRANS CODEVT231 ONE-TIME MAILING ADDRESS (For this transaction only - address will not show on your customer record)CITY, STATE, ZIP CODEPRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF (check one)MAILING ADDRESS - (If different from residence)CITY, STATE, ZIP CODECOUNTY OF RESIDENCECOUNTY OF MAILINGOWNERORLESSEECITY, STATE, ZIP CODEVEHICLE ADDRESS - (Location of vehicle if different from residence)COUNTY (of vehicle address or use)CITY, STATE, ZIP CODE78910564 DEPARTMENT OF TRANSPORTATIONDRIVER AND MOTOR VEHICLE SERVICES1905 LANA AVE NE, SALEM oregon 97314 DMVEXPLATE CODEMPPLATE TRANSFER FEEGASELECTRICPROPANEOTHER:DIESELHYBRIDP LUG-INNATURALHYBRID%QORNGVG.

9 KPG YKVJ VJG QYPGT YJQUG CFFTGUU YKNN DG WUGF HQT CNN &/8 OCKN TGICTFKPI VJKU XGJKENG .KUV CFFKVKQPCN QYPGTU QP .KPGU CPF 6 JKU KP PQ YC[ FGVGTOKPGU C RTKQTKV[ QH QYPGTUJKR +H CP[ QYPGT NKUVGF WUGU CP CIGPE[ CFFTGUU QP &/8 TGEQTFU VJCV QYPGT OWUV DG UJQYP QP .KPG 5GG TGXGTUG HQT OQTG KPHQTOCVKQP This application cannot be used to change or correct the name(s) shown on the title or to change ,%8 &5%,Vehicles subject to weight-mile tax must be registered with the Motor Carrier Transportation Division (MCTD) of ODOT. This appliesprimarily to vehicles with a registration weight of 26,001 pounds or OF REGISTERED OWNERXI certify this vehicle is not required to be registered through the Motor Carrier Transportation Division and is not subject to weight-miletax.]]]]

10 I understand it is a crime under ORS to certify the truth of a statement when you know the statement is not true. Such acrime is punishable by a jail sentence of up to one year, a fine up to $6,250 or Vehicles: If this vehicle is not listed in your farm file and a farm identification number is not assigned, or if you have notcompleted a Farm Certification Application (Form 735-9670), you must attach a Farm Certification Application to this form. If you havequestions, call the Farm Desk at (503) Vehicles: If you have not applied for registration previously for this vehicle, or if the registration for this vehicle isexpired you must complete an Application for Tow or Recovery Vehicle Certification (Form 735-387) and attach it to this VEHICLE AND/OR TOW RECOVERY REGISTRATIONIf you do not know if your vehicle is subject to weight-mile tax, contact the Motor Carrier Transportation Division, &AIRVIEW )NDUSTRIAL $RIVE 3%, Salem OR 9730.


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