9%!2
$SSOLFDWLRQIRU
7LWOHDQG5HJLVWUDWLRQ
REMARKS:
REPLACEMENT FEE
4)4,%&%%
6).&%%
,!4%4)4,%&%%
727$/)((
PLATE TRANSFER
2%'2%.&%%
%15)0-%.4
&,%%4!##/5.4
02%3%.4/2%'/.0,!4%
6%()#,%)$%.4)&)#!4)/..5-"%26).
25(*217,7/(
&!2-)$
/$/-%4%22%!$).'./4%.4(3
$!4%/&2%!$).'--$$9999
THE MILEAGE STATED IS IN EXCESS OF ITS MECHANICAL LIMITS HAS ROLLED OVER OR
THE ODOMETER READING IS ./4 ACTUAL MILEAGE
,FHUWLI\WKDWWRWKHEHVWRIP\NQRZOHGJHWKHRGRPHWHUUHDGLQJ
LV aFWXDO PLOHDJH81/(66RQHRIWKHVHER[HVLVPDUNHG
-!+%
349,%
2%'7%)'(4,%.'4(
'!3
%,%#42)#
02/0!.% 27+(5
$)%3%, (9"2)$
75$,/(529(5
/%6
12
<(6
9%3
03*
6).).30%#4)/. $!4%).)4)!,3
,%6#/-0,)!.4
./
$%!,%2
3/8*,1
1$785$/
*$6
+<%5,'
&,%8&5%,
&RPSOHWHDOODSSOLFDEOHareaV0$,/72'09/DQD$YH1(6DOHP25RUWDNHWRDQ\'09RIILFH
'(3$570(172)75$163257$7,21
'5,9(5$1'027259(+,&/(6(59,&(6
/$1$$9(1(6$/(025(*21
DM V
$%!,%2
ODOMETER: Federal and State laws require that you state the mileage when you transfer ownership on a vehicle model year 2011 or newer until that
vehicle is 20 years old or older. Use this certification when required to provide the odometer disclosure but unable to provide the proper disclosure from the
seller. I certify the odometer disclosure listed is true and correct and a disclosure is not available on the required form from the seller. Failure to
complete an odometer disclosure or providing a false statement to meet this requirement is a Class C felony under ORS 815.430.
42!.3
*9:5
75$,/(529(5
)((7:,'(
12
9%3
VEHICLE
INFORMATION
DMV USE ONLY
4
COUNTY FEE
WARNING - odometer discrepancy
ONE-TIME MAILING ADDRESS (Will not change your customer record)
Reg. Only
Title Only
Both

3%#52)49).4%2%34(/,$%2"ANK&INANCE#OMPANY0ERSONETC
3%#52)49).4%2%34(/,$%2!$$2%33).#,5$%342%%4#)4934!4%:)0#/$%
/$,)$#534/-%2
3%#/.$!29).4%2%34(/,$%2"ANK&INANCE#OMPANY0ERSONETC
3%#/.$!29).4%2%34(/,$%2!$$2%33).#,5$%342%%4#)4934!4%:)0#/$%
,%33/2#OMPLETEONLYIFLESSEEISSHOWNASOWNERON,INEABOVE
,%33/2!$$2%33).#,5$%342%%4#)4934!4%:)0#/$%
/$,)$#534/-%2
/$,)$#534/-%2
13
14
15
16
17
18
6859,9256+,3
12
-2,172:1(525/(66((35,17)8///(*$/1$0(/$67),5670,''/( See "Change of Address" on reverse)
#)4934!4%:)0#/$%
$!4%/&")24(--$$9999
$!4%/&")24(--$$9999
/$,)$#534/-%2 $!4%/&")24(--$$999902).4&5,,,%'!,.!-%/$67),5670,''/(/&CHECKONE
2%3)$%.#%"53).%33!$$2%33(Address will be used to update your ODL / ID card) -!),).'!$$2%33 (If different from residence – will be used to update your ODL / ID card)
#)4934!4%:)0#/$% #/5.49/&2%3)$%.#% #/5.49/&-!),).'
-2,172:1(525/(66((35,17)8///(*$/1$0(/$67),5670,''/( See "Change of Address" on reverse)
/7.%2 /2 ,%33%%
#)4934!4%:)0#/$%
/$,)$#534/-%2
/$,)$#534/-%2
#/5.49OFVEHICLEADDRESSORUSE
#)4934!4%:)0#/$%

*OINT/WNERSOR,ESSEESAGREETHATTITLEWILLSHOWJOINTOWNERSHIPWITHRIGHTOFSURVIVORSHIP
*OINT3ECURITY)NTEREST(OLDERSAGREETHATTITLEWILLSHOWJOINTSECURITYINTERESTWITHRIGHTOFSURVIVORSHIP
N
N
9%3
9%3
./
./
&RPSOHWH/LQHZLWKWKHRZQHUZKRVHDGGUHVVZLOOEHXVHGIRUDOO'09PDLOUHJDUGLQJWKLVYHKLFOH/LVWDGGLWLRQDORZQHUVRQ/LQHVDQG 7KLVLQQRZD\GHWHUPLQHVDSULRULW\RIRZQHUVKLS,IDQ\RZQHU
OLVWHGXVHVDZRUNDGGUHVVRQ'09UHFRUGVWKDWRZQHUPXVWEHVKRZQRQ/LQH6HHUHYHUVHIRUPRUHLQIRUPDWLRQ
OWNER
or LESSEE / ADDRESS
VEHICLE ADDRESS (Vehicle location if different from residence, or park model RV site)
CERTIFICATIONS
SECURITY INTEREST HOLDER
LESSOR
$!4%/&")24(--$$9999
4%,%0(/.%

$!4%/&")24(--$$9999
4%,%0(/.%

$!4%/&")24(--$$9999
4%,%0(/.%

8QGHU2UHJRQODZLWLVDFULPHWRNQRZLQJO\PDNHDQ\IDOVHVWDWHPHQWRQDQDSSOLFDWLRQIRUWLWOHRUUHJLVWUDWLRQ 256DQG
7KHVHRIIHQVHVDUH&ODVV$PLVGHPHDQRUVDQGSXQLVKDEOHE\DMDLOVHQWHQFHRIXSWRRQH\HDUDILQHRIXSWRRUERWK%\VLJQLQJWKLVDSSOLFDWLRQ,
FHUWLI\DOOLQIRUPDWLRQRQWKLVIRUPLVWUXHDQGFRUUHFWDQGDJUHHZLWKDOODSSOLFDEOHVWDWHPHQWVEHORZDQGRQWKHEDFNRIWKLVIRUP
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.
).352!.#%#/-0!.9.OTAGENT
0/,)#9
19
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).
REPLACEMENT OREGON TITLE:
□
If this box is checked, I certify that to the best of my knowledge the Oregon title is lost, destroyed or mutilated.
3)'.!452%/&/7.%2/2,%33%%!33(/7.!"/6%
20
;
3)'.!452%/&,%33/22EQUIREDIFSECURITYINTERESTHOLDERISDIFFERENTTHANLESSOR
21
;
735-226 (7-24)
$!4%
$!4%
4%,%0(/.%

4%,%0(/.%

STK# 300097
SIGNATURES
Clear Form
VEHICLE IDENTIFICATION NUMBER (VIN):
FORM INFORMATION
ASSEMBLED, RECONSTRUCTED OR
REPLICA VEHICLE CERTIFICATION
DMV links all records together based on your customer
number. Always use your customer number and the same
name with DMV.
Individual Customer Number: Your customer number is
your Oregon driver license (ODL), identification card
(ID) or instruction permit number if you have one. If you do
not have an Oregon customer number, one will be assigned
to you.
Business Customer Number: If you know your business
customer number, list it on the application.
One-time Mailing Address: Where you want the title and/or
registration document mailed if different than residence or
mailing.
Vehicle Address: Where the vehicle is primarily housed or
dispatched from if different address than the residence or
business.
Address Change: Only the address listed for the owner
shown on Line 5 will be changed if it is different than DMV
records. DMV will update your vehicle and driver record.
Additional owners can change their address online at
DMV2U.oregon.gov.
Work Address: If an owner has a work/public agency
address on file with DMV and wants that address to be used
for the vehicle record, that person must be listed on Line 5
and the work address listed on Lines 6 and 7. If a security
interest holder, they must be listed on Line 13 and the work
address listed on Line 14.
COMMERCIAL VEHICLE DRUG AND ALCOHOL TESTING CERTIFICATION
I certify:
Certify below if this is the first time the vehicle is being
titled as assembled, reconstructed or replica (not on
current title) or you are certifying to a new incident.
I certify this vehicle is:
□
Assembled
• Does not look like any certain year or make of
vehicle; and
• Not rebuilt by a manufacturer or built in a factory
where the year and make are assigned at the factory;
and
• Not an antique, special interest, reconstructed or
replica vehicle.
□
Reconstructed
• Body looks like and mostly is a certain year or make
of vehicle; and
• Not rebuilt by a manufacturer or built in a factory
where the year and make are assigned at the factory;
and
• Is not a replica; or
• Is a motor truck rebuilt using a component kit, if the
manufacturer of the kit assigned a VIN and provided
a Certificate of Origin for the kit.
□
Replica
• Body built to look like and be a reproduction of a
particular year model and make of vehicle.
• Includes vehicles built as replicas from new,
reconditioned, or original parts; or reconstructed
from existing vehicles or parts of vehicles, and the
vehicle
would otherwise meet the replica definition.
Commercial vehicle: I know the applicable federal motor carrier safety regulations and hazardous materials regulations or
compatible state regulations.
Registered with truck (T) plates: I have an in-house drug and alcohol testing program that meets the federal requirements; or
I am a member of a consortium that provides testing that meets federal requirements; or I am exempt from the above
requirements.
Name of person(s) operating consortium: __________________________________________________________________
RECREATIONAL VEHICLE CERTIFICATION
If a recreational vehicle, I certify it meets the NFPA 1192, NFPA 501C or ANSI A119.2 standard in effect at the time of
manufacture.
VEHICLE USE CERTIFICATION
If this is initial registration of a tow/recovery vehicle, or initial registration, renewal, or continuation of registration by a new
owner of a manufactured structure toter, farm, or charitable/non-profit vehicle, I certify the vehicle and its use qualify for
special registration and conform to the law.
MILITARY BENEFIT INFORMATION REQUEST
I am a member or veteran of a uniformed service and want DMV to send my name and address to the Oregon Department
of Veterans’ Affairs so I can get benefit information.
Name(s): _______________________________________________________________________
hearing.
SPECIALTY PLATE CHOICE – PASSENGER VEHICLES ONLY
Mark the box for the type of special plate you want.
□
Crater Lake
DEAF OR HARD OF HEARING NOTE ON VEHICLE RECORD
□
Add a Deaf/Hard of Hearing note to my registration card, to show that someone driving my vehicle may be deaf or hard of
□
Cultural
□
Gray Whale
□
Smokey Bear
□
Trail Blazer
□
UO Duck
□
Wine Country
□
Salmon
□
Wildlife
□
Pollinator Paradise
□ Other _______________
NOTES
–
-735-226 (7-24)