This form contains 52 fields organized into 1 section. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Vehicle Identification Number Text
Enter the Vehicle Identification Number (VIN) of the motorized bicycle.
Engine Number Text
Enter the engine number of the motorized bicycle.
Make Text
Enter the make or manufacturer of the motorized bicycle.
California License Plate Text
Enter the California license plate number for the motorized bicycle, if applicable.
Model Text
Enter the model of the motorized bicycle.
Distinctive Marks or Features Text
Provide a description of any distinctive marks or features of the motorized bicycle.
Original application for license plate and ID Card Checkbox
Check this box if you are submitting an original application for a license plate and ID card, and have completed Sections 1, 2, and 5.
Apply for duplicate ID Card and/or substitute license plate Checkbox
Check this box if you are applying for a duplicate ID card or a substitute license plate, and have completed Sections 1, 3, and 5.
Transfer ownership Checkbox
Check this box if you are transferring ownership of the vehicle, and have completed Sections 1, 4, and 5.
Question 3 No Checkbox
Check this box if your vehicle does not have an automatic transmission and a motor with less than 4 gross brake horsepower.
Question 4 No Checkbox
Check this box if your vehicle's maximum speed is not 30 miles per hour on level ground.
Question 4 Yes Checkbox
Check this box if your vehicle has a maximum speed of 30 miles per hour on level ground.
Question 2 No Checkbox
Check this box if your vehicle does not have fully operative pedals for human power or is not powered solely by electrical energy.
Question 3 Yes Checkbox
Check this box if your vehicle has an automatic transmission and a motor with less than 4 gross brake horsepower.
Question 1 No Checkbox
Check this box if your vehicle is not a two-wheel or three-wheel device.
Question 2 Yes Checkbox
Check this box if your vehicle has fully operative pedals for human power or is powered solely by electrical energy.
Question 1 Yes Checkbox
Check this box if your vehicle is a two-wheel or three-wheel device.
Owner Name AND Checkbox
Check this box if there are multiple owners and their names should be joined by 'AND'.
Owner Name OR Checkbox
Check this box if there are multiple owners and their names should be joined by 'OR'.
Owner's Full Name Text
Enter the true full name of the owner(s) (last, first, middle).
Driver License or ID Card Number Text
Enter the owner's driver license or identification card number.
Address Text
Enter the street address of the owner.
County Text
Enter the county of the owner's address.
City Text
Enter the city of the owner's address.
State Text
Enter the state of the owner's address.
Max length: 2 characters
Zip Code Text
Enter the zip code of the owner's address.
Substitute Plate Checkbox
Check this box if you are requesting a substitute plate.
Duplicate ID Card Checkbox
Check this box if you are requesting a duplicate ID card.
Item Lost/Stolen Checkbox
Check this box if the item(s) has/have been lost or stolen.
Item Destroyed/Mutilated Checkbox
Check this box if the item(s) has/have been destroyed or mutilated.
Item Surrendered to DMV Checkbox
Check this box if the item(s) has/have been surrendered to the Department of Motor Vehicles (DMV).
Item Not Received from DMV Checkbox
Check this box if the item(s) has/have not been received from the Department of Motor Vehicles (DMV).
Item Not Received from Prior Owner Checkbox
Check this box if the item(s) has/have not been received from the prior owner.
Seller's Printed Name Text
Enter the printed full name of the seller who is releasing interest in the vehicle.
Seller's Signature Date Date
Enter the date the seller signed to release interest in the vehicle.
New Owner Name AND Checkbox
Check this box if there are multiple new registered owners and their names should be joined by 'AND'.
New Owner Name OR Checkbox
Check this box if there are multiple new registered owners and their names should be joined by 'OR'.
New Owner's Full Name Text
Enter the true full name of the new registered owner(s) (last, first, middle).
New Owner Driver License or ID Card Number Text
Enter the new owner's driver license or identification card number.
New Owner Zip Code Text
Enter the zip code of the new owner's address.
New Owner State Text
Enter the state of the new owner's address.
Max length: 2 characters
New Owner City Text
Enter the city of the new owner's address.
New Owner County Text
Enter the county of the new owner's address.
New Owner Address Text
Enter the street address of the new owner.
New Owner 1 Signature Date Date
Enter the date the first new owner signed the certification.
New Owner 1 Daytime Telephone Area Code Text
Enter the area code for the first new owner's daytime telephone number.
Max length: 3 characters
New Owner 1 Daytime Telephone Number Text
Enter the remaining digits for the first new owner's daytime telephone number.
New Owner 2 Signature Date Date
Enter the date the second new owner signed the certification.
New Owner 2 Daytime Telephone Area Code Text
Enter the area code for the second new owner's daytime telephone number.
Max length: 3 characters
New Owner 2 Daytime Telephone Number Text
Enter the remaining digits for the second new owner's daytime telephone number.
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