DMV Form REG 256 – Fill Out and Use This PDF

DMV Form REG 256 is a document used by the California Department of Motor Vehicles (DMV) in the United States. This form, also known as the Statement of Facts, is used to provide additional information to the DMV regarding a specific transaction or situation related to a vehicle or driver's license.

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Dmv Form Reg 256 PDF Details

The DMV Form REG 256 is typically used to provide information related to vehicle registration, such as changes in ownership or registration status, and to request special license plates or exemptions from certain requirements. The form can also be used to provide information related to driver's license applications, such as changes in personal information or to explain any unusual circumstances that may affect the application.

The listing provides information about the dmv form reg 256. It is a good idea that you check out this info before you begin editing the PDF.

Question	Answer
Form Name	DMV Form REG 256
Form Length	2 pages
Fillable?	Yes
Fillable fields	58
Avg. time to fill out	12 min 10 sec
Other names	dmv statement of facts, ca dmv statement of facts, dmv reg 256, reg 256 dmv ca

12

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	MISCELLANEOUS CERTIFICATIONS
A Public Service Agency	Complete the appropriate section(s) and sign in Section F.
LICENSE PLATE/CF NUMBER	VEHICLE/VESSEL ID NUMBER	YEAR/MAKE

SECTION A — CERTIFICATION FOR DISABLED VETERAN LICENSE PLATES

Disabled Veteran Only (California Vehicle Code (CVC) §9105)

I understand that disabled veteran exempt registration is valid for one vehicle only. I own the above described vehicle that is not used for transportation for hire, compensation, or profit. The unladen weight of the vehicle is less than 8,001 pounds (commercial vehicle only).

I am a disabled veteran who, as a result of injury or disease suffered while on active service with the armed forces of the United States, suffers from the following disability(s) - Check appropriate box(es):

I have a disability which has been rated at 100% by the United States Department of Veterans Affairs, due to a diagnosed

disease or disorder which substantially impairs or interferes with my mobility.

I am so severely disabled as to be unable to move without the aid of an assistant device. I have, or have lost the use of, one or more limbs.

I have suffered permanent blindness, as defined in Section 19153 of the Welfare and Institutions Code.

I am submitting the required medical certification or documentation (see other side), which certifies I meet the definition of a disabled veteran under CVC §295.7.

SECTION B — TAIPEI ECONOMIC AND CULTURAL OFFICE (TECO) REVENUE AND TAXATION CODE (RTC) §10781

As required, attached to this application are photocopies of a Tax Exemption Card issued by the Board of Equalization and an ID card issued by the Department of State.

SECTION C — INDIAN CERTIFICATIONS—Indians residing on a federally recognized indian reservation or rancheria. CVC §9104.5 and RTC §10781.1

Indian-owned vehicles driven on public highways are exempt from license fees only. Tribal owned vehicles used exclusively within the boundaries of their tribe are exempt from weight and license fees.


I am a member of the				tribe and living on the		federal reservation or rancheria.
This vehicle will be registered to the							tribe and
will	will not be used exclusively within tribal boundaries.

Residency must be verified by an authorized member of the tribal council or an official of the Bureau of Indian Affairs, U. S. Government. Signature and residence verification is acceptable on tribal letterhead.

AUTHORIZED SIGNATURE

X

TITLE

DATE

SECTION D — STOLEN OR EMBEZZLED VEHICLE CERTIFICATION

I am the owner or title holder of the vehicle described above which was stolen/embezzled on or about

.

This is what happened:

DATE

. I reported

the theft/embezzlement to fees became due.

. I was not in possession of this vehicle when the renewal

POLICE AGENCY

The police agency recovered the vehicle on		and I took possession of the vehicle on		.
	DATE		DATE

SECTION E — CERTIFICATION OF VEHICLE FOR HUMAN HABITATION

Definition: Human habitation is living space which includes, but is not limited to: closets, cabinets, kitchen units or fixtures, and bath or toilet rooms.

This is a new vehicle manufactured for human habitation.
This is a new vehicle that was modified for human habitation by a licensed van converter.
This vehicle was permanently modified (			camper attached	converted to motorhome.) The modification was completed
on		.
	DATE
1.	Cost of the complete vehicle before it was modified:			$
2.	Cost of changes, including labor:			$		+
3.	Total value:			$		=	$ 0.00

SECTION F — APPLICANT SIGNATURE

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

SIGNATURE

X

DATE

TELEPHONE NUMBER

( )

REG 256A (REV. 1/2021) WWW

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REQUIREMENTS FOR DISABLED VETERAN LICENSE PLATES

INSTRUCTIONS: In order to qualify for exempt registration benefits for one vehicle and Disabled Veteran License Plates, an eligible disabled veteran must submit the following to the Department of Motor Vehicles:

1)A completed and signed Miscellaneous Certificate, (DMV Form REG 256A with section A and F completed).

2)A copy of proof of true full name and date of birth. A valid driver license (DL) or identification (ID) card is acceptable, as is any document necessary to apply for a California DL or ID card.

3)One of the following required documentation:

a)The medical certification below, completed and signed by one of the medical professionals indicated.

b)A certification completed and signed by a County Veterans Service Officer that certifies the applicant is a disabled veteran as described in California Vehicle Code (CVC) §295.7.

c)A certification completed and signed by an authorized representative of the Department of Veterans Affairs (CalVet) that certifies the applicant is a disabled veteran as described in CVC §295.7.

d)A certification completed and signed by an authorized representative of the United States Department of Veterans Affairs that certifies the applicant is a disabled veteran as described in CVC §295.7.

Submit all required documentation by mail to DMV at:

Department of Motor Vehicles

Special Processing Unit, MS D238

P.O. Box 932345

Sacramento, CA 94232-0001

MEDICAL CERTIFICATION FOR DISABLED VETERAN LICENSE PLATES

This is to certify that

is a disabled veteran as defined in CVC §295.7 and as a

VETERAN’S NAME

result of injury or disease suffered while on active service with the armed forces of the United States suffers from the following disability(s) - Check appropriate box(es):

Has a disability which has been rated at 100% by the United States Department of Veterans Affairs or the military service from which the veteran was discharged, due to a diagnosed disease or disorder which substantially impairs or interferes with mobility.

Is so severely disabled as to be unable to move without the aid of an assistant device. Has lost, or has lost use of, one or more limbs.

Has suffered permanent blindness, as defined in Section 19153 of the Welfare and Institutions Code.

I certify that I,			, am a (check one)
		DOCTOR/PRACTITIONER’S NAME
Physician		Surgeon	Chiropractor	Podiatrist
Optometrist		Physician Assistant	Nurse Practitioner	Certified Nurse-Midwife

I certify under penalty of perjury under the laws of the State of California that the information I have provided is true and correct. I further certify that information sufficient to substantiate this certification shall be retained and made available for inspection by the Medical Board of California or the appropriate regulatory board at the department’s request. (CVC §5007).

EXECUTED AT (CITY/STATE)		DATE

MEDICAL PROVIDER SIGNATURE	MEDICAL LICENSE NUMBER
X
MEDICAL PROVIDER ADDRESS	CITY	STATE	ZIP CODE

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REG 256A (REV. 1/2021) WWW

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california dmv forms blanks to fill in

Include the asked information in the tribe, and, living, on, the federal, reservation, or, rancher, i, a tribe, and TITLE, DATE, DATE, POLICE, AGENCY DATE, and, I, took, possession, of, the, vehicle, on and DATE box.

Filling out california dmv forms part 2

Focus on the most essential details of the camper, attached DATE, SECTION, F, APPLICANT, SIGNATURE DATE, TELEPHONE, NUMBER and REG, ARE, V, WWW segment.

Filling out california dmv forms step 3

The field has to be applied to note the rights or obligations of both parties.

Completing california dmv forms step 4

End up by reviewing all these fields and completing them as required: VETERANS, NAME I, certify, that, I Physician, Optometrist DOCTOR, PRACTITIONERS, NAME Surgeon, Physician, Assistant ama, check, one Chiropractor, Nurse, Practitioner Podiatrist, Certified, Nurse, Midwife DATE, MEDICAL, PROVIDER, SIGNATURE MEDICAL, PROVIDER, ADDRESS MEDICAL, LICENSE, NUMBER CITY, STATE, and ZIP, CODE

california dmv forms VETERANSNAME, IcertifythatI, PhysicianOptometrist, DOCTORPRACTITIONERSNAME, SurgeonPhysicianAssistant, amacheckone, ChiropractorNursePractitioner, PodiatristCertifiedNurseMidwife, DATE, MEDICALPROVIDERSIGNATURE, MEDICALPROVIDERADDRESS, MEDICALLICENSENUMBER, CITY, STATE, and ZIPCODE fields to fill out

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