Inf 1126 Form – Fill Out and Use This PDF

FEE: $5.00 Per Request—YOUR REQUEST WILL NOT BE PROCESSED WITHOUT THE APPROPRIATE NON-REFUNDABLE FEE

NOTICE TO REQUESTERS: As a condition to the disclosure of information from records maintained by the Department of Motor Vehicles, the subject of record may be provided a copy of this request.

This form is used to obtain names and addresses of the registered owner, legal owner, and interested parties of a vehicle valued under $300 which you intend to dispose of pursuant to CVC §22851.3 or CVC §22851.8 or conduct a Lien Sale on a vehicle valued under $4000 (CC §3072) or vessel valued under $1500 (Harbors/Navigation Code §504).

DESTRUCTION OF RECORDS: Business entities are responsible for destroying DMV record information containing personal informa- tion, such as name, driver license or identification number, or physical characteristics, etc. no longer required for their business purposes by shredding, erasing, or modifying the personal information to make it unreadable or undecipherable as provided in Civil Code Sections 1798.80, 1798.81, and 1798.82.

ANY OTHER USE OF THE INFORMATION RECEIVED IS PROHIBITED

ALL SECTIONS MUST BE COMPLETE OR REQUEST WILL BE RETURNED

PART A: Requester’s Information		PLEASE PRINT CLEARLY
BUSINESS NAME OR FIRST NAME	M.I.	LAST	AREA CODE DAYTIME TELEPHONE NUMBER
			(	)
ADDRESS
CITY		STATE	ZIP CODE

PART B: Record Search Criteria Complete all search criteria for vehicles. Contact your local DMV for assistance if the vehicle identification number (VIN) is mutilated or missing on vehicle. Complete vessel CF number and hull identification number (HIN). The current registered and legal owner record information on file with the department will be provided.

VEHICLE LICENSE OR VESSEL CF NUMBER	STATE LAST REGISTERED	MAKE	YEAR	MODEL
VIN OR HIN		MOTORCYCLE ENGINE NUMBER

PART C: Reason For Request Explain why the vehicle/vessel is subject to a lien sale—include statute and section number if known.

Please Note: This section must be completed or your request will be refused.

The basis for my lien is ________________________________________________________________________________________

__________________________________________________________________________________________________________

The vehicle/vessel came into my possession on___________________ Current vehicle/vessel value __________________________

How was the vehicle/vessel acquired? ____________________________________________________________________________

Where is the vehicle/vessel currently located? ______________________________________________________________________

PART D: Certification, Signature/Requester Identification Complete “executed at” information. Read certification statement, sign and print your driver license/or identification card (DL/ID) number. DL/ID must match signature of requester to release record.

I certify under penalty of perjury under the laws of the State of California, that the information entered by me on this document is true and correct and will only be used to notify the registered and legal owner(s) of, and all persons known to claim an interest in, this vehicle/vessel as required by the laws of the State of California and the California Vehicle Code (CVC), Civil Code (CC), and/or the Harbors and Navigation Code. I further certify that I have read and understand the applicable statutes identified above and I agree to abide by all the requirements stated therein.

I understand that I may be subject to prosecution for false representation (CVC §1808.45) for any false statement regarding this request which is a misdemeanor and punishable by a maximum fine of five thousand dollars ($5,000) or a maximum imprisonment of one year in the county jail, or both.

SIGNATURE OF REQUESTER

REQUESTER DL/ID NUMBER

X

PART E: Mailing Label Do Not Detach Complete this section in order to receive the requested record information.

INF 1126 (REV. 2/2003) WWW