VEHICLE LICENSE PLATE OR VESSEL CF NUMBER VEHICLE/HULL IDENTIFICATION NUMBER (VIN) MAKE OF VEHICLE/VESSEL BUILDER
LAST, FIRST, MIDDLE CALIFORNIA DRIVER LICENSE OR ID CARD NUMBER
CALIFORNIA DRIVER LICENSE OR ID CARD NUMBER
CALIFORNIA DRIVER LICENSE OR ID CARD NUMBER
ADDRESS PURCHASE DATE
CITY STATE ZIP CODE PURCHASE PRICE
FOR LEASED VEHICLES ONLY—Lessee address if different from address above.
FOR VESSELS ONLY—Vessel principally kept at (address or location).
AND
OR
AND
OR
STATEMENT TO RECORD OWNERSHIP
NAME OF LIEN HOLDER (IF “NONE”, SO STATE)
ADDRESS
CITY STATE ZIP CODE
ADDRESS
CITY STATE ZIP CODE
REG 101 (REV. 3/2007) WWW
A Public Service Agency
$
VEHICLE INFORMATION
REGISTERED OWNER—Print or typewrite true full name(s) as it appears on California Driver License or ID Card
LIEN HOLDER—Print or typewrite true full name(s)
STATEMENT OF ERROR OR ERASURE
REASONS FOR ERROR ERASURE
SIGNATURE DATE
ADDRESS
CITY STATE DAYTIME TELEPHONE NO.
VEHICLE LICENSE PLATE OR VESSEL CF NO.
VEHICLE/HULL IDENTIFICATION NUMBER MAKE OF VEHICLE OR VESSEL BUILDER
The name appearing on or erased from line __________ of the CERTIFICATE OF TITLE/OWNERSHIP issued for the
above described vehicle/vessel was in error and has no bearing on the ownership of the vehicle/vessel. The name signed
or erased should not be a part of the ownership record.
A Public Service Agency
REG 101 (REV. 3/2007) WWW
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
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