DMV Application for Replacement / Duplicate Title
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
DMV USE ONLY
If there are ANY changes in ownership, and if renewing registration, you must complete an Application for
Title and Registration (Form 735-226) in addition to this form. Please read the instructions on the back of
THIS FORM CAREFULLY BEFORE COMPLETING THIS APPLICATION
0DLO WR '09 /DQD $YH 1( 6DOHP 25 RU WDNH WR DQ\ '09 RIILFH
03* '($/(5180%(5 TITLE FEE
$%!,%2
42!.3 $
Complete Lines 1 through 18. The ownership information must reflect what is currently shown on DMV records.
VEHICLE
PRESENT OREGON PLATE # YEAR MAKE STYLE VEHICLE IDENTIFICATION NUMBER (VIN) /2%'/. TITLE
1
INFO.
EQUIPMENT # REG WEIGHT / LENGTH GVWR OVER YES GAS DIESEL HYBRID PLUG-IN &,%8 &5%,
HYBRID
2 NATURAL
26,000 LBS. NO ELECTRIC PROPANE OTHER:
GAS
List additional owners on Lines 6 and 7. (This in no way determines a priority of ownership.)
If any owner listed uses a work address on DMV records, that owner must be shown on Line 3.
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF (check one) OWNER OR LESSEE ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
3
RESIDENCE ADDRESS - )F OWNER IS A BUSINESS USE BUSINESS ADDRESS MAILING ADDRESS - )F DIFFERENT FROM RESIDENCE
or LESSEE / ADDRESS
CITY, STATE, ZIP CODE COUNTY OF RESIDENCE CITY, STATE, ZIP CODE COUNTY OF MAILING
5
OWNER
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF JOINT OWNER OR LESSEE ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
6
PRINT FULL LEGAL NAME: LAST, FIRST, MIDDLE OF JOINT OWNER OR LESSEE ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
7
/.% 4)-% -!),).' !$$2%33 (For this transaction only - address will not show on your customer record) Reg. Only VEHICLE ADDRESS - (Location of vehicle if different from residence OR PARK MODEL 26 SITE
8 Title Only
Both
CITY, STATE, ZIP CODE CITY, STATE, ZIP CODE COUNTY (of vehicle address or use)
9
SECURITY INTEREST HOLDER (Bank, Finance Company, Person, etc.) ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
10
SECURITY INTEREST HOLDER
SECURITY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE TELEPHONE #
11
( )
and/or LESSOR
SECONDARY INTEREST HOLDER (Bank, Finance Company, Person, etc.) ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
12
SECONDARY INTEREST HOLDER ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE TELEPHONE #
13
( )
LESSOR (Complete only if lessee is shown as owner on Line 3 above) ODL / ID / CUSTOMER # DATE OF BIRTH (MM/DD/YYYY)
14
LESSOR ADDRESS - INCLUDE STREET / CITY / STATE / ZIP CODE TELEPHONE #
15
( )
The owner must certify by completing all applicable statements and sign the application to apply for title and registration in Oregon. Under
#%24)&)#!4)/.3
Oregon law, it is a crime to knowingly make any false statement on an application for title or registration (ORS 803.070 / ORS 803.385). Both
offenses are Class A misdemeanors and are punishable by a jail sentence of up to one year, a fine of up to $6,250 or both.
I hereby request a replacement title and certify to the best of my knowledge the title for this vehicle has been lost, destroyed or mutilated, and
to the best of my knowledge has not been signed, conveyed or transferred to another party. (If mutilated, the title or what remains of the title is
attached.) If I, as the title holder on DMV records, cannot certify what happened to the title, the additional signature of the person who has this
knowledge appears on Line 18.
PLEASE NOTE: SIGNATURES ON THIS FORM DO NOT RELEASE INTEREST.
SIGNATURE OF OWNER, SECURITY INTEREST HOLDER OR LESSOR DATE 4%,%PHONE # ( )
16
X
SIGNATURES
4%,%0(/.% # ( )
SIGNATURE OF OWNER, SECURITY INTEREST HOLDER OR LESSOR DATE 4%,%0(/.% # ( )
17
X 4%,%0(/.% # ( )
SIGNATURE OF PERSON CERTIFYING THE TITLE IS LOST, DESTROYED, OR MUTILATED, IF NOT AN OWNER SHOWN ON DMV RECORDS.
SIGNATURE DATE
18
X
4 STK# 300164
● WHEN TO USE THIS FORM ●
Use this form if your title has been lost, destroyed, or mutilated.
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