MUST COMPLETE VEHICLE INFORMATION BELOW:
VEHICLE IDENTIFICATION NUMBER VEHICLE MAKE YEAR MODEL
SECTION 5 — DATE INFORMATION
DATE VEHICLE ENTERED OR WILL ENTER CALIFORNIA (CA):
Month Day Year
If vehicle was previously registered in CA, then registered or located
out-of-state and has now returned to CA, enter most recent date vehicle
entered CA. If you did not own vehicle at time of entry, check this box:
DATE VEHICLE FIRST OPERATED IN CALIFORNIA:
Month Day Year
Or enter date vehicle will be operated, if it has not been operated
yet.
DATE YOU WENT TO WORK IN CALIFORNIA, OBTAINED A CA DRIVER LICENSE, OR BECAME A RESIDENT:
Month Day Year
Enter the date whichever occurred rst. If you have been a resident
since birth, enter date of birth. If you are not a CA resident, check
this box:
DATE VEHICLE WAS PURCHASED OR ACQUIRED:
Month Day Year
AND WAS (CHECK BOX):
New Used
AND WAS PURCHASED (CHECK BOX):
Inside CA Outside CA
SECTION 6 — COST INFORMATION
NOTE: The total cost or value of the vehicle must include the cost of the basic vehicle, value of any trade-in, and all accessories and leased
equipment permanently attached. Cost does not include sales tax, insurance, nance charges, or warranty.
MuST CHECk ONE bOx ONLY, AND ENTER REquIRED INFORMATION FOR THAT ONE bOx:
PURCHASE – I purchased the vehicle for the price of $
.
GIFT – I acquired the vehicle as a gift. Its current market value is $
.
A Statement of Facts (REG 256) form must be completed.
TRADE – I acquired the vehicle as a trade. Its value when I acquired it was $ .
VEHICLE WAS PURCHASED OR ACQUIRED FROM:
Dealer Private Party Dismantler
Immediate Family Member – State
Relationship:
FOR ALL VEHICLES:
Since purchasing or acquiring this vehicle, were any body type modications, additions and/or alterations (e.g., changing from pickup to utility,
etc.) made to this vehicle? If yes, a Statement of Construction (REG 5036) form must be completed. ......................................
Yes
No
FOR REVIVED JUNK OR REVIVED SALVAGE VEHICLES:
The cost of the vehicle must include the labor cost, whether or not the labor was provided or done by you. The total cost of the vehicle including
labor is $
.
SECTION 7 — FOR OuT-OF-STATE OR OuT-OF-COuNTRY VEHICLES
For vehicles which enter the state within 1 year of purchase, was Sales Tax paid to another state? ............................ N/A Yes No
If yes, enter amount of tax paid $
(this amount will be credited toward any Use Tax in CA). If your vehicle was last
registered in another state, you may be eligible for a Use Tax exemption. For more information, contact the Board of Equalization (www.boe.ca.gov).
For commercial vehicles (including pickups), this vehicle was last registered as a:
Commercial Vehicle Non-commercial Automobile in
the last state of registration.
DISPOSITION OF OUT-OF-STATE PLATES:
The plates will not be affixed to any vehicle at any time, unless the vehicle is “Dual Registered” in both states. The plates are:
Expired, or will be or were:
Surrendered to CA DMV Destroyed Retained Returned to the motor vehicle department of the state of issuance.
SECTION 8 — MILITARY SERVICE INFORMATION
Are you or your spouse on active duty as a member of the U.S. Uniformed Services? ............................................................... Yes No
If yes, you may qualify for an exemption. Refer to Nonresident Military Exemption (REG 5045) form.
When this vehicle was last licensed, were you or your spouse on active duty as a member of the U.S. Uniformed Services? ... Yes No
If yes, in what state or country were you or your spouse stationed?
SECTION 9 — CERTIFICATIONS Signatures required.
The signature for a company or business MUST include the printed name of the company/business and an authorized representative’s
countersignature on the signature line (e.g., ABC CO. by JOHN SMITH or JOHN SMITH for ABC CO.).
The registered owner mailing address is valid, existing, and an accurate mailing address. I consent to receive service of process at this mailing
address pursuant to CVC §1808.21.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
PRINTED NAME OWNER’S SIGNATURE
x
DAT E DAYTIME TELEPHONE NUMBER
( )
PRINTED NAME CO-OWNER’S SIGNATURE
x
DAT E DAYTIME TELEPHONE NUMBER
( )
PRINTED NAME CO-OWNER’S SIGNATURE
x
DAT E DAYTIME TELEPHONE NUMBER
( )
REG 343 (REV. 2/2012) WWW
