Application For Duplicate or Paperless Title: A Public Service Agency
Application For Duplicate or Paperless Title: A Public Service Agency
1/2012)
APPLICATION FOR DUPLICATE
OR PAPERLESS TITLE
DMV USE ONLY
DL/ID # STATE TECH. INITIALS
Duplicate Title (Complete Sections 1 - 3) Paperless Title Certifcation (Complete Sections 1 - 3)
Transfer of Title with Duplicate or Paperless Title (Seller completes Sections 1 - 4, New Owner completes Sections 6 and 7, as needed.)
VEHICLE LICENSE PLATE OR VESSEL CF NUMBER VEHICLE/HULL IDENTIFICATION NUMBER YEAR/MAKE OF VEHICLE OR VESSEL BUILDER
SECTION 1 REGISTERED OWNER(S) OF RECORD Please print name as it appears on the Title/Registration.
TRUE FULL NAME (LAST, FIRST, MIDDLE, SUFFIX), BUSINESS NAME, OR LESSOR DRIVER LICENSE/ID CARD NUMBER STATE
CO-OWNER TRUE FULL NAME (LAST, FIRST, MIDDLE, SUFFIX) DRIVER LICENSE/ID CARD NUMBER STATE
PHYSICAL RESIDENCE OR BUSINESS ADDRESS (INCLUDE ST., AVE., ETC.) APT./SPACE/STE. # CITY STATE ZIP CODE
COUNTY OF RESIDENCE OR COUNTY WHERE VEHICLE/VESSEL IS PRINCIPALLY GARAGED
MAILING ADDRESS (IF DIFFERENT FROM ABOVE) APT./SPACE/STE. # CITY STATE ZIP CODE
SECTION 2 LEGAL OWNER OF RECORD (LIENHOLDER/TITLE HOLDER) Do not enter name of owners above.
NAME OF BANK, FINANCE COMPANY, OR INDIVIDUAL HAVING A LIEN ON THIS VEHICLE ELECTRONIC LIENHOLDER ID NUMBER
ELT #
BUSINESS OR RESIDENCE ADDRESS APT./SPACE/STE. # CITY STATE ZIP CODE
SECTION 3 MISSING TITLE STATEMENT WARNING: Issuance of a duplicate title cancels the original title.
The Certifcate of Title issued for this vehicle/vessel is (check box): Lost Stolen Paperless Title
Not Received from Prior Owner Not Received from DMV (Allow 30 days from issue date) Illegible/Mutilated (Attach old title)
I agree to indemnify and save harmless the Director of Motor Vehicles for any loss suffered resulting from the issuance of said duplicate
Certifcate of Title. 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 OF OWNER SIGNATURE OF OWNER
X
DATE DAYTIME TELEPHONE NUMBER
( )
SECTION 4 REGISTERED OWNER(S) RELEASE OF OWNERSHIP AND/OR INTEREST
I/we release interest in the described vehicle/vessel. NOTE: The signature of EACH owner is required if co-owners are joined by AND (shown
by / on DMV records). The signature for a company or business MUST include the printed name of the company/business and an authorized
representatives countersignature on the signature line (e.g., ABC CO., by JOHN SMITH - or - JOSEPH SMITH for ABC CO).
PRINTED NAME OF OWNER SIGNATURE OF OWNER
X
DATE DAYTIME TELEPHONE NUMBER
( )
PRINTED NAME OF OWNER SIGNATURE OF OWNER
X
DATE DAYTIME TELEPHONE NUMBER
( )
SECTION 5 LEGAL OWNER OF RECORD RELEASE OF OWNERSHIP AND/OR INTEREST Must be notarized.
The undersigned lienholder (legal owner of record) certifes release of interest in the vehicle/vessel. For vehicles 2 model years old and
newer, the legal owner (i.e., bank, fnance company, etc.) of record must apply for a duplicate title frst, and then release interest on the actual
title. This section and the Lien Satisfied (REG 166) form cannot be used.
PRINTED NAME OF AUTHORIZED AGENT SIGNING FOR COMPANY TITLE OF AUTHORIZED AGENT SIGNING FOR COMPANY DAYTIME TELEPHONE NUMBER
( )
SIGNATURE OF LEGAL OWNER (COMPANY NAME AND AUTHORIZED AGENTS COUNTERSIGNATURE)
X
DATE
NOTARY USE ONLY
State of California
County of
On
before me, ,
personally appeared , who proved to
me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
(SEAL)
SIGNATURE
(HERE INSERT NAME AND TITLE OF THE OFFICER)
STATE OF CALIFORNIA
DEPARTMENT OF MOTORVEHICLES