This form contains 52 fields organized into 6 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Certification and Signatures
Date Text
Enter the date you are certifying or declaring under penalty of perjury that the information provided is true and correct.
Daytime telephone number(code) Text
Enter the area code of your daytime telephone number. This field accepts a maximum of 3 digits.
Max length: 3 characters
Telephone number Text
Enter your daytime telephone number.
Date Text
Enter the date of the second signature certifying or declaring under penalty of perjury that the information provided is true and correct.
Daytime telephone number(code) Text
Enter the area code of the second owner's daytime telephone number. This field accepts a maximum of 3 digits.
Max length: 3 characters
Telephone number Text
Enter the daytime telephone number of the second owner.
Check One
Check if substitute plate CheckBox
Check this box if you are applying for a substitute plate.
Check if duplicate ID card CheckBox
Check this box if you are applying for a duplicate ID card.
Lost/Stolen CheckBox
Check this box if the item or items have been lost or stolen.
Destroyed/Mutilated CheckBox
Check this box if the item or items have been destroyed or mutilated.
Surrendered to DMV CheckBox
Check this box if the item or items have been surrendered to the DMV.
Not Received from DMV CheckBox
Check this box if the item or items have not been received from the DMV.
Not Received from Prior Owner CheckBox
Check this box if the item or items have not been received from the prior owner.
Form Actions
Print Button
Click this button to print the form.
Clear Form Button
Click this button to clear all the fields in the form.
Original Application
1. Two wheel or three wheel device? Check if yes CheckBox
Check this box if the moped is a two-wheel or three-wheel device. This is part of determining if your vehicle qualifies as a motorized bicycle.
1. Two wheel or three wheel device? Check if no CheckBox
Check this box if the moped is not a two-wheel or three-wheel device.
2. Fully operative pedals for human power or powered solely by electrical energy? Check if yes CheckBox
Check this box if the moped has fully operative pedals for human power or is powered solely by electrical energy.
2. Fully operative pedals for human power or powered solely by electrical energy? Check if no CheckBox
Check this box if the moped does not have fully operative pedals for human power or is not powered solely by electrical energy.
3. Automatic transmission and a motor with less than 4 gross brake horsepower? Check if yes CheckBox
Check this box if the moped has an automatic transmission and a motor with less than 4 gross brake horsepower.
3. Automatic transmission and a motor with less than 4 gross brake horsepower? Check if no CheckBox
Check this box if the moped does not have an automatic transmission or has a motor with 4 or more gross brake horsepower.
4. Maximum speed of 30 miles per hour on level ground? Check if yes CheckBox
Check this box if the moped has a maximum speed of 30 miles per hour on level ground.
4. Maximum speed of 30 miles per hour on level ground? Check if no CheckBox
Check this box if the moped does not have a maximum speed of 30 miles per hour on level ground.
True full name of owner or owners. (Last, first, middle) Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the true full name of the owner or owners (last, first, middle).
Driver license or ID card Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the driver's license or ID card number of the owner.
Check if and CheckBox
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, check this box if the ownership should be considered jointly (AND).
Check if or CheckBox
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, check this box if the ownership should be considered separately (OR).
Address Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the street address of the applicant.
County Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the county of the applicant.
City Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the city of the applicant.
State Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the state of the applicant. Use the 2-letter state abbreviation.
Max length: 2 characters
Zip code Text
Fill this field only if you answer 'Yes' to these questions: 1. Two wheel or three wheel device? 2. Fully operative pedals for human power or powered solely by electrical energy? 3. Automatic transmission and a motor with less than 4 gross brake horsepower? 4. Maximum speed of 30 miles per hour on level ground?. If so, enter the ZIP code of the applicant.
Ownership Transfer
Printed name of seller Text
Enter the printed name of the seller releasing interest in the vehicle.
Date Text
Enter the date of the transaction or event.
New registered owner(s). Last, first, middle Text
Enter the full name (last, first, middle) of the new registered owner.
Driver license or ID card Text
Enter the driver's license or ID card number of the new registered owner.
Check AND CheckBox
Check this box if all new registered owners will share joint ownership and must act together ('AND' condition).
Check OR CheckBox
Check this box if any of the new registered owners can act independently ('OR' condition).
Address Text
Enter the street address of the new registered owner.
County Text
Enter the county of the new registered owner.
City Text
Enter the city of the new registered owner.
State Text
Enter the state of the new registered owner. Use the 2-letter state abbreviation.
Max length: 2 characters
Zip Code Text
Enter the ZIP code of your current address.
Vehicle Information
Vehicle Identification Number Text
Enter the Vehicle Identification Number (VIN) of the moped.
Engine Number Text
Enter the engine number of the moped.
Make Text
Enter the make (manufacturer) of the moped.
California License Plate Text
Enter the California license plate number of the moped, if available.
Model Text
Enter the model of the moped.
Distinctive marks or features Text
Enter any distinctive marks or features of the moped.
Check if original application for license plate and I D card. CheckBox
Check this box if you are submitting an original application for a license plate and ID card. Complete sections 1, 2, and 5.
Check if apply for duplicate ID card and or substitute license plate. CheckBox
Check this box if you are applying for a duplicate ID card and/or substitute license plate. Complete sections 1, 3, and 5.
Check if transferring ownership. CheckBox
Check this box if you are transferring ownership of the moped. Complete sections 1, 4, and 5.