CERTIFICATION OF VEHICLE
DATE OF PURCHASE
(Complete one side of this form only.)
INSTRUCTIONS: Use this certification in support of an application for title when:
•
The release date or date of purchase shown on other documentation is not the actual purchase date,
-- OR --
•
There is no documentation which shows the actual date of purchase.
DATE OF PURCHASE PLATE NUMBER VEHICLE IDENTIFICATION NUMBER
I certify the date shown above is the true date of purchase. If other documents submitted with this
application for title show a different date of purchase, I certify the date shown on the other
documents is not the true date of purchase and should be disregarded.
I understand that it is a crime under ORS 803.070 to certify the truth of a statement when I know
the statement is not true. This offense is a Class A misdemeanor.
NAME (PLEASE PRINT)
SIGNATURE DATE
X
735-6775 (2-21)
STK # 300386
LATE TITLE TRANSFER FEE EXEMPTION CERTIFICATION
I purchased this vehicle on
I CERTIFY THAT THE FOLLOWING INFORMATION IS TRUE AND CORRECT
(Complete one side of this form only.)
Oregon law requires that the title (or its equivalent) be submitted to DMV for transfer within 30 days from the date you buy a vehicle. If
you do not submit the title, DMV must charge you a late title transfer fee. (The fee is $25 when the title is presented on the 31st
through the 60th day after the date of purchase. The fee increases to a maximum of $50 on the 61st day after the date of purchase.)
There are some exceptions due to the following conditions:
•
You did not have possession of the title (or its equivalent) to submit to DMV for reasons beyond your control,
*Once you have possession of the title or are no longer incapacitated, you must submit it to DMV within 30 days.
You were mentally or physically incapacitated following the purchase of the vehicle preventing you from submitting the title to DMV.*
•
--OR--
____________________. I came into possession of the title (or its equivalent) on ____________________.
(MONTH) (DAY) (YEAR) (MONTH) (DAY) (YEAR)
....................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................
PLATE NUMBER YEAR MAKE BODY STYLE VEHICLE IDENTIFICATION NUMBER
Failure to deliver the title within 30 days was beyond my control because: (DMV may ask you to provide proof of this).
I further certify that this certification is made in support of an application for title.
I understand that it is a crime under ORS 803.070 to certify the truth of a statement when I know the statement is not true. This offense is a Class A
misdemeanor.
NAME (PLEASE PRINT)
SIGNATURE DATE
X
735-6775 (2-21)
