812

User Manual: 812

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812

STATE OF ALASKA
DIVISION OF MOTOR VEHICLES

OWNER
INFORMATION

VEHICLE
INFORMATION

APPLICATION
TYPE

VEHICLE TRANSACTION APPLICATION
REGISTRATION

TITLE

YEAR

CO-OWNER
INFORMATION

 LOST TAB  LOST PLATE  OTHER _______________

I AM ALSO APPLYING FOR AN EXEMPTION:
 SENIOR (65+)  MILITARY  GUARD  DISABILITY  CHARITABLE/GOVERNMENT
 PERMANENT REGISTRATION (I LIVE IN AN ELIGIBLE AREA)  OTHER ________________

SERIAL NUMBER (VIN)

SECONDARY SERIAL NUMBER (VIN)
MAKE

MODEL

ODOMETER (MILES)

BODY STYLE

 ACTUAL
 ESTIMATED

WEIGHT

FULL FIRST NAME

FULL MIDDLE NAME

DRIVER LICENSE #

STATE

IS VEHICLE USED
COMMERCIALLY

 YES
 NO

COLOR

 NEW PLATES

AK LICENSE PLATE #

REQUESTED

FULL LAST NAME

DATE OF BIRTH

SUFFIX

ORGAN DONOR

 YES
COMPANY OR TRUST NAME (If applicable)

SOCIAL SECURITY NO.

 NO

TAXPAYER ID NO.

“AND”
“OR”

CONTACT
INFORMATION

 REGISTRATION

 CHANGE OF OWNERSHIP
 REPLACEMENT TITLE
 CORRECTION / ADD OR REMOVE LIENHOLDER

Are you an Alaska
Resident?

 YES
 NO

CONJUNCTION TYPE
requires the signatures of ALL owners to sell / transfer
requires the signature of a single owner to sell / transfer

FULL FIRST NAME

FULL MIDDLE NAME

DRIVER LICENSE #

STATE

FULL LAST NAME
DATE OF BIRTH

SUFFIX

ORGAN DONOR

 YES
LEASING COMPANY, COMPANY, OR TRUST (If applicable)

SOCIAL SECURITY NO.

 NO

TAXPAYER ID NUMBER

Are you an Alaska
Resident?

 YES
 NO

OWNER MAILING ADDRESS

CITY

STATE

ZIP

OWNER RESIDENCE ADDRESS

CITY

STATE

ZIP

EMAIL ADDRESS

PHONE #

I WANT TO RECEIVE NOTIFICATIONS BY:
REGULAR MAIL
E-MAIL

LEASING COMPANY MAILING ADDRESS

CITY

STATE

ZIP

COMMERCIAL

COMMERCIAL VEHICLES, LEASED VEHICLES, VEHICLES OWNED BY A COMPANY, OR VEHICLES WEIGHING MORE THAN 10,000 POUNDS
DURATION OF REGISTRATION
Heavy Vehicle Use Tax Declaration
DOT NO.
NO. OF AXLES

 ANNUAL  BIENNIAL

 IRS 2290 ATTACHED  EXEMPT

IS THE CARRIER RESPONSIBLE FOR SAFE OPERATION
EXPECTED TO CHANGE DURING THE REGISTRATION PERIOD?



 YES
 NO

TAX ID ASSOC. WITH DOT NO.

 DUAL REGIST. REQUESTED
CURR REG. IN ______________



PRISM
SUBJECT TO
EXEMPT Must Certify below*
* I certify under penalty of perjury that I am the owner of the vehicle listed above; AND the vehicle does not require a USDOT number.
Owner’s Printed Name
Owner’s Signature

Date

OTHER INFORMATION

LIENHOLDER NAME (If vehicle is paid in full – write “NONE”)
LIENHOLDER ADDRESS: (PO Box or Street Address)

DO YOU WISH TO DONATE $1 OR MORE TO SUPPORT THE
ORGAN AND TISSUE DONATION PROGRAM?

CITY / STATE / ZIP CODE

 YES

Personalized Plate Transfer

 NO

 I would like to transfer my personalize plate to this vehicle
Plate #:

AMOUNT $ ____________
AFFIDAVIT

I certify under penalty of law there is a liability insurance policy for this vehicle if required by AS 28.22.011 and this policy will be maintained
during the entire registration period. The address shown is my true legal address and the vehicle will be operated on Alaska roadways. If this
is a commercial vehicle, I am familiar with and have knowledge of the Federal Motor Carrier Safety Regulations 49 CFR, Hazardous Materials
Regulations and applicable Federal/state CMV safety laws and regulations. I certify under penalty of perjury that all information is true and
correct. False statements are punishable under AS 11.56.210.

X
SIGNATURE OF OWNER / AGENT (INCLUDE TITLE)
X
SIGNATURE OF OWNER / AGENT (INCLUDE TITLE)

Form 812 (Rev. 07/2017)

/

/

/

/

DATE

DMV USE ONLY
DOCUMENTS ACCEPTED

CLASS CODE: _________________
BATCH NO: ___________________
DATE: ______________________

DATE

www.alaska.gov/dmv

LOGIN ID :____________________
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