OFFICE OF FOREIGN MISSIONS
DIPLOMATIC MOTOR VEHICLE OFFICE
APPLICATION FOR TITLE
SEE INSTRUCTIONS ON REVERSE
B. BUYER IS NOT A FOREIGN NATIONAL ACTING AS AN OFFICIAL REPRESENTATIVE.
U.S. Department of State
OMB Approval No. 1405-0072
Expires 03-31-2006
*Estimated burden 30 minutes
FOR OFFICE USE ONLY
Do Not Write
in this space
COUNTRY MISSION TYPE (Embassy, Consulate, UN, OAS, Other)
ADDRESS (No., Street, Apt., City, State, Zip Code)
OWNER NAME (Surname)
(First) (MI)
I.D. NUMBER
PRINCIPAL
DEPENDENT
VEHICLE IDENTIFICATION NUMBER MAKE MODEL
BODY
LIEN HOLDER/LEGAL OWNER (Name in Full) If the registered owner is the legal owner, write NONE.
YEAR WEIGHT ODOMETER
ADDRESS
BUYER NAME (Surname)
ADDRESS (No., Street, Apt., City, State, Zip Code)
The undersigned certifies that, in accordance with the provisions of Title 18 U.S. Code, Section 1001,
prohibiting the making of false statements in connection with a federal matter, the information stated here is
true and correct.
(EMBASSY SEAL)
OWNER'S SIGNATURE DATE (mm-dd-yyyy)
LICENSE PLATE NO.
ATTENTION: Application cannot be processed without completion of gray shaded areas.
DATE OF BIRTH (mm-dd-yyyy) VISA
CO-OWNER NAME (Surname) (First)
(MI)
I.D. NUMBER
PRINCIPAL
DEPENDENT
DATE OF BIRTH (mm-dd-yyyy) VISA
COLOR
CO-OWNER'S SIGNATURE DATE (mm-dd-yyyy)
DS-102
03-2003
A. BUYER IS AN OFFICIAL REPRESENTATIVE OF:
TITLE TO:
SELF/TERMINATING SELL EXPORT
TRANSFER TO ANOTHER
DIPLOMAT/EMPLOYEE
(First)
(MI)
(Country) (Mission Type)
THE OFFICIAL (DIPLOMATIC, CONSUL, STAFF) FEDERAL LICENSE PLATES ISSUED FOR THIS VEHICLE WILL
NOT BE REMOVED FROM THE VEHICLE UNTIL AUTHORIZED BY THE U.S. DEPARTMENT OF STATE, OFFICE
OF FOREIGN MISSIONS AND THE OFFICIAL FEDERAL LICENSE PLATES WILL BE RETURNED TO THE OFFICE
OF FOREIGN MISSIONS.
LR:
P:
T#:
TITLE MOVED TO:
NAME
I.D.#
TAG NO.
EXPIRATION DATE
R:
PRODUCTION
DATES
(Q):
(N):
(C):
E:
I:
F:
* The response time is an estimated average including the time needed to look for, get, and provide the
information required. You do not have to provide the information requested if the OMB approved has expired. We
would appreciate any comments on the estimated response burdens, and recommendations for reducing them.
Please send your comments to A/RPS/DIR, U.S. Department of State, Washington, DC 20520.
Page 1 of 2
(Formerly DSP-102)
