12/10/2011 6:27 AM
TRANSMITTAL OF REGISTRATION APPLICATIONS
DMV TRANSMITTAL SHEET (Submitter will complete shaded area only)
DEPT USE ONLY
T LIST NO.
(dlr name)
( dlr address) CHECK ONE CHECK ONE
(dlr city )
DEALER TELEPHONE NO. R/S TELEPHONE NO. DT RECVD OR POST MK
REFUND PICKUP
CREDIT MAIL
DLR #
(1) (2) (3) (4) (5) (6) (7) (7a) (7b) (7c) (7d) (8)
AMT OF
VIN OR LICENSE DLR REPORT OF SALE OR DMV FEES ASF/ISF
BUYER'S NAME DISMNTL ACQ NO
kk RECEIPT NUMBER AMT# CASH OR TOTAL REFUND
NUMBER COLLECT DUE
U S D CHK
REC'D BY DEPT. REP. NAME SR/AR Credit
RO (HQ/REF)
TOTALS 0
TOTAL CK/CASH TOTAL AMT. REC'D.
$0.00
SR/AR ISSUED (MASTER RECEIPT) SUBMITTER'S COMMENTS
CK#/PRIOR CREDIT #
ASF/ISF will be filled by Sacramento , Headquarters
CALL OR FAX FOR
ADDITIONAL FEES
FEES PAID AFTER SUBMISSION OF THIS LIST
Fees submitted for ASF/ISF $ ____________________
$ CHECK #
SR/AR # ISSUED BY (DEPT. REP.)
Receipt # _______________________________________
Submitter's Rep X ________________
DT REQUESTED/AMT REQUEST BY DATE REC'D.
By: Department Rep X________________________________________________________________________
RLN - MBSB- DMV BUNDLE TEMPLATE