DMV USE ONLY
DM V
Application for Replacement / Duplicate Title
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
If there are ANY changes in ownership, and if renewing registration, you must complete an Application for
Title and Registration (Form 735-226) in addition to this form. Please read the instructions on the back of
this form carefully before completing this application.
Mail to: DMV, 1905 Lana Ave NE, Salem OR 97314 or take to any DMV office.
MPG DEALER NUMBER
TITLE FEE
$%!,%2
42!.3
$
VEHICLE
INFO.
Complete Lines 1 through 18. The ownership information must reflect what is currently shown on DMV records.
PRESENT OREGON PLATE #
YEAR
MAKE
STYLE
VEHICLE IDENTIFICATION NUMBER (VIN) OREGON TITLE #
1
EQUIPMENT # REG WEIGHT / LENGTH
PLUG-IN
GVWR OVER YES
GAS
DIESEL HYBRID &,%8&5%,
HYBRID
2
26,000 LBS.
NATURAL
NO
ELECTRIC PROPANE
OTHER:
GAS
ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY) PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF (check one)
MAILING ADDRESS - )FDIFFERENTFROMRESIDENCE RESIDENCE ADDRESS - )FOWNERISABUSINESSUSEBUSINESSADDRESS
COUNTY OF RESIDENCE CITY, STATE, ZIP CODE COUNTY OF MAILING
OWNER OR LESSEE
CITY, STATE, ZIP CODE
3
4
5
List additional owners on Lines 6 and 7. (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 3.
OWNER
or LESSEE / ADDRESS
6
7
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF JOINT OWNER OR LESSEE
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF JOINT OWNER OR LESSEE
ODL / ID / CUSTOMER #
ODL / ID / CUSTOMER #
DATE OF BIRTH (MM/DD/YYYY)
DATE OF BIRTH (MM/DD/YYYY)
8
/.%4)-%-!),).'!$$2%33(For this transaction only - address will not show on your customer record)
Reg. Only
Title Only
Both
9
CITY, STATE, ZIP CODE
VEHICLE ADDRESS - (Location of vehicle if different from residence, or park model RV site)
CITY, STATE, ZIP CODE COUNTY (of vehicle address or use)
SECURITY INTEREST HOLDER
and/or LESSOR
SECURITY INTEREST HOLDER (Bank, Finance Company, Person, etc.) ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
10
SECURITY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE TELEPHONE #
11
( )
SECONDARY INTEREST HOLDER (Bank, Finance Company, Person, etc.) ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
12
SECONDARY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE TELEPHONE #
13
( )
LESSOR (Complete only if lessee is shown as owner on Line 3 above) ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
14
LESSOR ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE TELEPHONE #
15
( )
CERTIFICATIONS
The owner must certify by completing all applicable statements and sign the application to apply for title and registration in Oregon. Under
Oregon law, it is a crime to knowingly make any false statement on an application for title or registration (ORS 803.070 / ORS 803.385). Both
offenses are Class A misdemeanors and are punishable by a jail sentence of up to one year, a fine of up to $6,250 or both.
I hereby request a replacement title and certify to the best of my knowledge the title for this vehicle has been lost, destroyed or mutilated, and
to the best of my knowledge has not been signed, conveyed or transferred to another party. (If mutilated, the title or what remains of the title is
attached.) If I, as the title holder on DMV records, cannot certify what happened to the title, the additional signature of the person who has this
knowledge appears on Line 18.
SIGNATURES
PLEASE NOTE: SIGNATURES ON THIS FORM DO NOT RELEASE INTEREST.
SIGNATURE OF OWNER, SECURITY INTEREST HOLDER OR LESSOR DATE
4%,%PHONE #
( )
16
4%,%0(/.% #
X
( )
SIGNATURE OF OWNER, SECURITY INTEREST HOLDER OR LESSOR DATE
4%,%0(/.% #
( )
17
4%,%0(/.% #
X
( )
SIGNATURE OF PERSON CERTIFYING THE TITLE IS LOST, DESTROYED, OR MUTILATED, IF NOT AN OWNER SHOWN ON DMV RECORDS.
SIGNATURE DATE
18
X
420)
STK# 300164
