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These particular parts are in the PDF template you'll be filling in.
Inside the segment PRINTED NAME OF AGENT IF APPLICABLE, OCCUPATIONAL LICENSE NUMBER IF, SECTION NONREPAIRABLE VEHICLE, A vehicle declared nonrepairable, VEHICLE LICENSE NUMBER, MAKE OF VEHICLE, YEAR, VEHICLE IDENTIFICATION NUMBER VIN, STATE OF LAST REGISTRATION, DATE REGISTRATION EXPIRES, CLAIM NUMBER, COSTVALUE, DATE WRECKED OR DESTROYED, DATE STOLEN, and DATE RECOVERED enter the details which the program demands you to do.
Provide the relevant information in the The license plates assigned to, Are being surrendered Plates, one, two, I certify or declare under penalty, DATE, REG C REV WWW, and SIGNATURE X field.
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