Reg 262

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

VEHICLE/VESSEL TRANSFER AND REASSIGNMENT FORM

A Public Service Agency


INSTRUCTIONS ON REVERSE SIDE - ALL SIGNATURES MUST BE IN INK - PHOTOCOPIES NOT ACCEPTED
This form is not the ownership certificate. It must accompany the titling document or ACQUISITION NUMBER (DISMANTLER ONLY)

Application for Duplicate Title. For Car Buyer's Bill of Rights, visit www.dmv.ca.gov.
VEHICLE/VESSEL ID

SECTION 1 - VEHICLE/VESSEL DESCRIPTION


IDENTIFICATION NUMBER YEAR MODEL MAKE LICENSE PLATE/CF NO. MOTORCYCLE ENGINE NUMBER

SECTION 2 - BILL OF SALE

I/We sell, transfer, and deliver the above vehicle/vessel


PRINT SELLER'S NAME(S)
BILL OF SALE

to GEICO on for the amount of $ N/A


PRINT BUYER'S NAME(S) MO DAY YEAR (SELLING PRICE)

If this was a gift, indicate relationship: (e.g., parents, spouse, friend, etc.) $
(GIFT VALUE)

SECTION 3 - ODOMETER DISCLOSURE STATEMENT (Void if Mileage is Altered or Erased)


Federal and State Law requires that you state the mileage upon transfer of ownership. Failure to complete or providing
a false statement may result in fines and/or imprisonment.
ODOMETER

The odometer now reads , 10


(no tenths) miles, and to the best of my knowledge
ths

reflects the ACTUAL mileage unless one of the following statements is checked.
WARNING - ODOMETER DISCREPANCY
Odometer reading is NOT the actual mileage Mileage EXCEEDS the odometer mechanical limits
Explain odometer discrepancy:

SECTION 4 - BUYER AND SELLER (MUST hand print his or her name, date and sign this section.)
BUYER'S SECTION
I acknowledge the odometer reading and the facts of the transfer. I certify (or declare) under penalty of perjury under
the laws of the State of California that the foregoing is true and correct.
PRINT BUYER'S NAME SIGNATURE DATE DL/ID OR DEALER/DISM #

x
BUYER

PRINT BUYER'S NAME SIGNATURE DATE DL/ID OR DEALER/DISM #

x
PRINT BUYER'S NAME SIGNATURE DATE DL/ID OR DEALER/DISM #

x
BUYER'S MAILING ADDRESS CITY STATE ZIP CODE DAYTIME TELEPHONE NO

SELLER'S SECTION
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
PRINT SELLER'S NAME SIGNATURE DATE DL/ID OR DEALER/DISM #

x
SELLER

PRINT SELLER'S NAME SIGNATURE DATE DL/ID OR DEALER/DISM #

x
PRINT SELLER'S NAME SIGNATURE DATE DL/ID OR DEALER/DISM #

x
SELLER'S MAILING ADDRESS CITY STATE ZIP CODE DAYTIME TELEPHONE NO

SECTION 5 - POWER OF ATTORNEY


POWER OF ATTORNEY

I/We appoint GEICO


PRINT NAME(S) PRINT NAME(S)
as my attorney in fact, to complete all necessary documents, as needed, to transfer ownership as required by law.
SIGNATURE REQUIRED BY PERSON APPOINTING POWER OF ATIORNEY DATE

x
SIGNATURE REQUIRED BY PERSON APPOINTING POWER OF ATIORNEY DATE

x
REG 262 (REV. 10/2011)

You might also like