Fillable VEHICLE TRANSACTION APPLICATION (State of Alaska)

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VEHICLE TRANSACTION APPLICATION (State of Alaska)

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STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
VEHICLE TRANSACTION APPLICATION
Form 812 (Rev. 10/2020) www.alaska.gov/dmv
812
APPLICATION
TYPE
TITLE
CHANGE OF OWNERSHIP
REPLACEMENT TITLE
CORRECTION / ADD OR REMOVE
LIENHOLDER
REGISTRATION
REGISTRATION LOST TAB LOST PLATE OTHER ____________
I AM ALSO APPLYING FOR AN EXEMPTION:
SENIOR (65+) MILITARY GUARD DISABILITY CHARITABLE/GOVERNMENT
PERMANENT REGISTRATION (I LIVE IN AN ELIGIBLE AREA) OTHER ________________
VEHICLE
INFORMATION
SERIAL NUMBER (VIN)
SECONDARY SERIAL NUMBER (VIN)
YEAR
MODEL
BODY STYLE
COLOR
ODOMETER
(MILES)
WEIGHT
ACTUAL
ESTIMATED
IS VEHICLE USED
COMMERCIALLY
CcCCCOMMERCI
ALLY?
YES NO
AK LICENSE
PLATE #
NEW PLATES
REQUESTED
INSURANCE COMPANY
INSURANCE POLICY NUMBER
OWNER
INFORMATION
FULL FIRST NAME
FULL MIDDLE NAME
FULL LAST NAME
SUFFIX
DRIVER LICENSE #
STATE
DATE OF BIRTH
ORGAN DONOR
YES NO
SOCIAL SECURITY NO.
COMPANY OR TRUST NAME (If applicable)
TAXPAYER ID NO.
Are you an
Alaska Resident?
YES
NO
CONJUNCTION TYPE
“AND” requires the signatures of ALL owners to sell / transfer
“OR” requires the signature of a single owner to sell / transfer
CO-OWNER
INFORMATION
FULL FIRST NAME
FULL MIDDLE NAME
FULL LAST NAME
SUFFIX
DRIVER LICENSE #
STATE
DATE OF BIRTH
ORGAN DONOR
YES NO
SOCIAL SECURITY NO.
LEASING COMPANY, COMPANY, OR TRUST (If applicable)
TAXPAYER ID NUMBER
Are you an Alaska
Resident?
YES
NO
CONTACT
INFORMATION
OWNER MAILING ADDRESS
CITY
STATE
ZIP
OWNER RESIDENCE ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS
PHONE #
I WANT TO RECEIVE NOTIFICATIONS BY:
REGULAR MAIL E-MAIL
LEASING COMPANY MAILING ADDRESS
CITY
STATE
ZIP
COMMERCIAL
COMMERCIAL VEHICLES, LEASED VEHICLES, VEHICLES OWNED BY A COMPANY, OR VEHICLES WEIGHING MORE THAN 10,000 POUNDS
DURATION OF REGISTRATION
ANNUAL BIENNIAL
Heavy Vehicle Use Tax Declaration
IRS 2290 ATTACHED EXEMPT
DOT NO.
NO. OF AXLES
IS THE CARRIER RESPONSIBLE FOR SAFE OPERATION
EXPECTED TO CHANGE DURING THE REGISTRATION
PERIOD?
YES
NO
TAX ID ASSOC. WITH DOT NO.
DUAL REGIST. REQUESTED
CURR REG. IN ______________
PRISM SUBJECT TO EXEMPT Must Certify below*
* I certify under penalty of perjury that I am the owner of the vehicle listed above; AND the vehicle does not require a USDOT number.
Owner’s/Agent’s Printed Name
Owner’s/Agent’s Signature
Date
OTHER INFORMATION
LIENHOLDER NAME (If vehicle is paid in full – write “NONE”)
LIENHOLDER ADDRESS: (PO Box or Street Address) CITY / STATE / ZIP CODE
DO YOU WISH TO DONATE $1 OR MORE TO SUPPORT THE
ORGAN AND TISSUE DONATION PROGRAM?
YES NO
AMOUNT $ ____________
Personalized Plate Transfer
I would like to transfer my personalized plate to this vehicle
Plate #:
AFFIDAVIT
I certify under penalty of law there is a liability insurance policy for this vehicle if required by AS 28.22.011 and this policy will be
maintained during the entire registration period. The address shown is my true legal address and the vehicle will be operated on
Alaska roadways. If this is a commercial vehicle, I am familiar with and have knowledge of the Federal Motor Carrier Safety
Regulations 49 CFR, Hazardous Materials Regulations and applicable Federal/state CMV safety laws and regulations. I certify
under penalty of perjury that all information is true and correct. False statements are punishable under AS 11.56.210.
X / /
SIGNATURE OF OWNER / AGENT (INCLUDE TITLE) DATE
X / /
SIGNATURE OF OWNER / AGENT (INCLUDE TITLE) DATE
DMV USE ONLY
DOCUMENTS ACCEPTED
CLASS CODE: _________________
BATCH NO: ___________________
DATE: _______________________
LOGIN ID: _______________________
Form 812 – HVUT
HEAVY VEHICLE USE TAX DOCUMENTATION
Important Information Regarding Alternate Proof of Payment for HVUT:
Due to the current health crisis, taxpayers who filed a paper Form 2290 to report and pay the highway use tax for the
taxable period July 1, 2020, through June 30, 2021, can expect a significant delay in receiving their IRS-stamped Form
2290 Schedule 1 receipt.
The Following are acceptable proof of payment for taxpayers who have filed a paper Form 2290 for HVUT for the
period July 1, 2020 through June 30, 2021, and have not received their IRS-Stamped Form 2290 Schedule 1 receipt:
The stamped Schedule 1 from the previous taxable period; July 1, 2019 through June 30, 2020; listing the VIN number of
the vehicle to be registered, or
A photocopy of the 2290 (with the Schedule 1 attached) that was filed with the IRS covering the current tax period for the
vehicle being registered, along with:
• photocopy of both sides of a cancelled check; or
• copy of the confirmation from the IRS electronic funds withdrawal, or
• copy of the taxpayer’s bank statement showing “IRS USA Tax Payment,” or similar language
Division Use Only – Select HVUT Documents Collected
The stamped Schedule 1 for Current taxable period, July 1, 2020 through June 30, 2021 listing:
The VIN number of the vehicle to be registered ALVIN Code 1
22 or more taxable vehicles listed by VIN that does not include the vehicle to be registered ALVIN Code E2
10 or more taxable vehicles listed by VIN for which the tax has been suspended that does not list the VIN of the vehicle to be registered ALVIN Code E3
Photocopy of the 2290 (with the Schedule 1 attached) without the stamp that was filed with the IRS along with: ALVIN Code 1
A photocopy of both sides of a cancelled check; or
A copy of the confirmation from the IRS electronic funds withdrawal, or
A copy of the taxpayer’s bank statement showing “IRS USA Tax Payment,” or similar language
For the previous taxable period; July 1, 2019 through June 30, 2020; the stamped Schedule 1, listing the VIN number of the vehicle to be registered ALVIN Code 1
Heavy Vehicle Use Tax Compliance Section (HVUT)
Motor Vehicles with a taxable gross weight of 55,000 pounds or more are subject to HVUT Compliance
Taxable gross weight is defined as the sum of the following:
• Empty weight of the motor vehicle, and
• Empty weight of trailer or semi-trailer(s) customarily used with motor vehicle, and
• Maximum load carried by the motor vehicle and on trailers or semi-trailers customarily used in combination with the motor vehicle
NOTE: Per A.S. 28.10.050 12 (c) The State of Alaska shall refuse to register a heavy motor vehicle subject to the federal highway use tax, if the applicant
fails to furnish proof, in accordance with 23 CFR 669
Last six digit of Vehicle Identification Number (VIN): _______________________________________
HVUT Documentation Attached? YES NO
Was this vehicle purchased within 60 days of the application for AK Registration? YES* NO ALVIN Code E1
*If yes, the date of sale will be verified on the titling documents and HVUT documents are not required for initial registration.
HVUT GROSS TAXABLE WEIGHT DECLARATION:
Under penalty of law, I certify by signing below, the vehicle has a taxable gross weight of 55.000 pounds or less and not subject to HVUT.
X / /
SIGNATURE OF OWNER/AGENT DATE
PRINTED NAME OF OWNER/AGENT SIGNING FOR COMPANY
COMPANY NAME
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VEHICLE TRANSACTION APPLICATION (State of Alaska)

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Completed 8 March 2021

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