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DM V |
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STATEMENT OF ERROR OR |
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ERASURE OF A NAME |
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DEPARTMENT OF TRANSPORTATION |
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DRIVER AND MOTOR VEHICLE SERVICES |
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1905 LANA AVE NE, SALEM OREGON 97314 |
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USE THIS FORM ONLY TO CORRECT AN ERROR OR
ERASURE IN A NAME WHEN APPLYING FOR TITLE.
COMPLETE ALL SECTIONS AS FOLLOWS:
1.Vehicle plate and identification number.
2.Check the applicable box.
3.Describe the error or erasure, using line number(s) where applicable.
4.Show how the entry should properly read. Make sure the application for title reflects this information by drawing one line through the error and writing in the correct information.
5.Printed name and signature of either:
a.Person or firm who made the error or whose name appears in error, OR
b.Person whose signature appears in error.
SECTION |
PLATE/REFERENCE NUMBER |
VEHICLE IDENTIFICATION NUMBER |
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1
The name appearing on, or erased from, the:
Title Application
SECTIONTitle
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Manufacturer’s Certificate of Origin
was in error and has no bearing on the ownership of the vehicle described above. The name should not be a part of the ownership record.
Describe the error or erasure:
SECTION
3
The entry should properly read as follows (if no entry write “blank”):
SECTION
4
I understand it is a crime, under ORS 803.075, to certify the truth of a statement when I know the statement is not true. Such a crime is a Class A misdemeanor punishable by a jail sentence of up to one year, a fine of $6,250, or both.
PRINTED NAMETITLE
SECTION
5 SIGNATURE |
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DATE |
X |
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735-502 (7-06) |
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USE THIS FORM FOR A NAME ONLY |
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STK# 300160 |
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