DMV $SSOLFDWLRQ IRU REMARKS: DMV USE ONLY 7LWOH …

2
ONE-TIME MAILING ADDRESS (Will not change your customer record) Reg. Only Title Only Both VEHICLE ADDRESS (Vehicle location if different from residence, or park model RV site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ee "Change of Address" on reverse) /$67 ),567 0,''/( (Address will be used to update your ODL / ID card) (If different from residence – will be used to update your ODL / ID card) -2,172:1(525/(66((35,17)8///(*$/1$0(/$67 ),567 0,''/( See "Change of Address" on reverse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or LESSEE / ADDRESS

Transcript of DMV $SSOLFDWLRQ IRU REMARKS: DMV USE ONLY 7LWOH …

Page 1: DMV $SSOLFDWLRQ IRU REMARKS: DMV USE ONLY 7LWOH …

226 1_18 Print.pdf 1 11/29/2017 12:00:28 PM

ONE-TIME MAILING ADDRESS (Will not change your customer record) Reg. OnlyTitle OnlyBoth

VEHICLE ADDRESS (Vehicle location if different from residence, or park model RV site)

7

REMARKS:

REPLACEMENT FEE

PLATE TRANSFER

See "Change of Address" on reverse)

(Address will be used to update your ODL / ID card) (If different from residence – will be used to update your ODL / ID card)

See "Change of Address" on reverse)

DMVSI

GNA

TURE

SCE

RTIF

ICAT

IONS

SECU

RITY

INTE

REST

HO

LDER

LESS

OR

VEHI

CLE

INFO

RMAT

ION

DMV

USE

ONL

YO

WNE

Ror

LES

SEE

/ ADD

RESS

Page 2: DMV $SSOLFDWLRQ IRU REMARKS: DMV USE ONLY 7LWOH …

RECREATIONAL VEHICLE / PARK

226 1_18 Print.pdf 4 11/29/2017 12:00:52 PM

DMV links all records together based on your customer number. Always use your customer number and the same name with DMV.Customer Number for Persons: Your customer number is your Oregon driver license (ODL), Identification card (ID) or instruction permit number. If you do not have an ODL, ID card or instruction permit, DMV will assign a customer number to you when the application is received. Use the name you have on your ODL, ID, or instruction permit when you have business with DMV. Always provide your date of birth (DOB).Customer Number for Businesses: If you know the customer number for your business, list that number on the application. Businesses must use the same name with DMV.Residence or Business Address: Provide the address where you primarily reside. If the owner listed is a lessee, the address of the lessee must be shown. For a business, provide the address of the business.Mailing Address: If you receive your mail at an address other than the residence or business address, complete the mailing address on Lines 6 and 7.One-time Mailing Address: For the title and/or registration document to be mailed to an address other than the residence, business, or mailing address, list the one-time mailing address on Lines 10 and 11.Vehicle Address: If the vehicle is primarily housed or dispatched from an address that is different than the residence or business address, complete the vehicle address on Lines 10 and 11. Park model recreational vehicles MUST list a vehicle address, even if it is the same as the residence or mailing.Change of Address: Only the address listed for the owner shown on Line 6 will be changed if it is different than DMV records. The address will be changed on both the vehicle and driver record. Additional owners can change their address online at DMV2U.oregon.gov.Work Address: If an applicant has a work address on file with DMV and wants that address to be used for the vehicle record, that person must be listed on Line 5 and the work address listed on Lines 6 and 7. If the person is a security interest holder, they must be listed on Line 14 and the work address listed on Line 15. To change your address to a work address, you must be eligible pursuant to ORS 802.250 and complete a Request for Police or Public Agency Address on DMV Records, Form 735-6438A. To change your address from a work address back to your residence address, you must request a change of address by mail to DMV Records Policy Unit, 1905 Lana Ave NE, Salem OR 97314.