(: Yes) Unchecked
(: Yes) Unchecked
(: Yes1) Unchecked
(: Yes1) Unchecked
(: Yes2) Unchecked
(10 07)
(check one)
(CLEAR) CLEAR
(If unavailable please explain usage or disposition below )
(PRINT) PRINT
(street city state zip code)
(text)
(text)
(text)
(text)
(text)
(text)
(text)
ADDRESS
And that the equipment (check whichever applies):
ATTACHED
BOE 28
BY (list below)
CALIFORNIA
CERTIFICATE
CERTIFICATES
CERTIFICATION AS TO USE OF EQUIPMENT BOARD
CLEARANCE
COVERING
EQUALIZATION
EQUIPMENT
EXCLUSIVELY
EXPLANATION
For the period(s) of:
Further that (please check one):
I hereby certify that the statements above are correct to the best of my knowledge and belief
ISSUED
Mail completed form to Motor Carrier Section MIC:65 State Board of Equalization PO Box 942879
NUMBER
PERMIT
PREVIOUSLY
PRIVATE
PROPERTY
RECEIVED
Sacramento CA 94279 0065 If you have any questions regarding specific vehicle transfers please telephone
SIGNATURETITLEADDRESS(street city state zip code) DATE
STATE
STORED
TAXES
TELEPHONE
the Motor Carrier Section at 916 322 9669
This vehicle has not been operated or it has been in the possession of:
UNAVAILABLE
