Pre-Owned EV Rebate - Sample Supporting Documents

Last Updated: July 24, 2024

Pre-Owned EV Rebate

Sample Supporting Documents

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Supporting Documents Required:

Document #1: Driver License ............................................................................................. 3

Document #2: Purchase or Lease Agreement .................................................................. 4

Sample A: Purchase Agreement or Lease Agreement ...................................................... 5

Sample B: Lease Agreement ................................................................................................... 6

Sample C: Vehicle Configuration and Final Price Sheet .................................................... 7

Sample D: Certificate of Title ................................................................................................. 8

Sample E: Electronic Lien and Title Document ................................................................... 9

Document #3: Proof of Vehicle Registration .................................................................. 10

Sample F: Permanent Registration Card ........................................................................... 11

Sample G: Temporary Registration ..................................................................................... 11

Document #4: IRS Form 4506-C ........................................................................................ 12

Sample H: IRS Form 4506-C ................................................................................................... 12

Document #5: Household Summary Form ..................................................................... 13

Sample I: Household Summary Form ................................................................................. 13

Document #6: Public Assistance Program Enrollment Document ............................... 14

Sample J: Income-Qualified Medi-Cal Notice of Action Approval Letter ..................... 15

Sample K: CalFresh/Food Stamps/SNAP Notice of Approval ......................................... 16

Sample L: Low Income Home Energy Assistance Program (LIHEAP) ............................ 17

Document #7: PG&E Electric Bill ...................................................................................... 18

Sample M: PG&E Electric Bill "Energy Statement" ........................................................... 18

Tip: To jump straight to a document on a desktop computer, hold down “CTRL” and click the name of the

document above.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #1: Driver License

A copy of the applicant’s current (not expired) California driver license should be submitted for proof of

residency. Please ensure all edges of the license are visible and all text is legible in your photo or scan.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #2: Purchase or Lease Agreement

If you purchased from a dealership or vehicle retailer:

• This is a legally binding contract that was signed at the dealership before taking delivery of your

vehicle. It stipulates the terms of purchase or lease. It may be on carbon paper or may be a

digital copy.

• You must submit a complete, clear and legible scan/photo with all pages present.

• You must submit a final copy (executed and signed). Note: Review or pro-forma copies are not

accepted. If you do not have the final copy, request it from your dealership or leasing agency.

• The date of purchase or lease shall be the date listed on the purchase or lease contract.

• You must submit one of the following documents as a complete purchase/lease agreement:

o Sample A: Purchase Agreement, if purchased

o Sample B: Lease Agreement, if leased

o Sample C: Vehicle Configuration AND Final Price Sheet, if applicable

• If you leased your vehicle prior to purchasing it, your original lease agreement is required in

addition to your recent purchase agreement.

o Please note, to be eligible, vehicles that were previously leased and later purchased

must have been originally leased as a used vehicle with a previous registered owner,

and your application must be submitted within 180 days of the original lease date.

Vehicles that were originally leased new or originally leased more than 180 days before

application submission are not eligible.

If you purchased from a private party seller (such as a person-to-person sale):

• If your vehicle was purchased from an individual in a private party sale, you must submit a copy

of your Certificate of Title (pink slip) listing the new owner’s information in place of an

agreement. The Transfer Date on the new owner’s Certificate of Title shall be considered the

date of purchase.

o Sample D: Certificate of Title

• If your vehicle was purchased from an individual in a private party sale, but a bank or credit

union holds the Certificate of Title, you must submit an Electronic Lien and Title document and

your signed loan agreement. In these cases, additional documentation may be required to

confirm your purchase date.

o Sample E: Electronic Lien and Title Document

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample A: Purchase Agreement or Lease Agreement

If you purchased from a dealership or vehicle retailer, scan all pages of your signed purchase/lease

agreement and combine them into one file. All sections, signatures, and pages must be present and

legible. This can be a carbon copy or a digital copy from your dealership.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample B: Lease Agreement

All sections, signatures, and pages must be present and legible. This can be a carbon copy or a digital

copy from your dealership. Please note, only vehicles leased as a used vehicle that have been

previously registered to another owner are eligible.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample C: Vehicle Configuration and Final Price Sheet

If you purchased your vehicle from a retailer that provides you with a Vehicle Configuration and Final

Price Sheet as your Motor Vehicle Purchase Agreement, both documents shown below must be

submitted together to create a complete purchase agreement.

Your Vehicle Configuration must list your VIN and the date “Accepted by Customer on” to be

considered complete. If your Vehicle Configuration is missing the date “Accepted by Customer on” we

may accept a copy of your signed Motor Vehicle Purchase Agreement Terms and Conditions or your

Delivery Declaration.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample D: Certificate of Title

If your vehicle was purchased from an individual in a private party sale and you do not have a current

loan or lienholder, you must submit a copy of your Certificate of Title (pink slip) listing the new owner’s

information in place of an agreement.

Your Certificate of Title (pink slip) copy must show the entire document, be unsigned, and must list the

applicant’s name and address.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample E: Electronic Lien and Title Document

If your vehicle was purchased from an individual in a private party sale, but a bank or credit union

holds the Certificate of Title, you must instead submit an Electronic Lien and Title document and a

complete copy of your signed loan agreement.

The Electronic Lien and Title paperwork must be obtained from your bank or credit union. This

document should show the vehicle and title information and dates of purchase.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #3: Proof of Vehicle Registration

• To provide proof of vehicle registration, you may submit either your registration card from the

Department of Motor Vehicles (DMV) or a valid temporary registration from your dealership.

• Your registration card is the document you receive in the mail from the DMV along with your

annual license plate sticker.

o Sample F: Permanent Registration Card

• Your temporary registration, sometimes referred to as the “Used Vehicle Dealer Notice,” is

often folded up and taped to your windshield by the dealership. If submitting the temporary

registration, be sure to unfold the document so all edges of the document are included. If your

temporary registration is missing required details, your permanent registration may still be

requested to help confirm program eligibility.

o Sample G: Temporary Registration

• The applicant’s name must be listed as a registered owner.

• Your vehicle must be registered to your current, residential PG&E address and your registration

document must be valid.

• Note: If the address on your registration is not your current, residential PG&E address, we do

not accept Change of Address forms from the DMV. You must get an updated registration card

listing your current address to be eligible.

• Your document must be a complete, legible scan or photo with all details visible.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample F: Permanent Registration Card

Sample G: Temporary Registration

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #4: IRS Form 4506-C

(if applying for Rebate Plus via Income Verification)

Sample H: IRS Form 4506-C

Note: This document only needs to be submitted if applying for Rebate Plus and not enrolled in one of

the qualified public assistance programs listed on Page 14.

• The prefilled version of this form will be provided to you during the application process. You

can also download a copy of this document here.

• Please sign and submit a complete, legible scan or photo with all sections in green filled out.

• Your “First taxpayer identification number” will be your Social Security Number (SSN) or your

individual taxpayer identification number (ITIN) (if the individual does not have an SSN).

• Please do NOT check off the boxes “Form 4506-C was signed by an Authorized Representative”

or “Signatory confirms document was electronically signed.”

Fill in all applicable fields in the

green sections.

Fill in all applicable fields in

the green sections.

This section is pre-filled

for your convenience.

Please DO NOT edit.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #5: Household Summary Form

(if applying for Rebate Plus via Income Verification)

Sample I: Household Summary Form

Note: This document only needs to be submitted if applying for Rebate Plus and not enrolled in one of

the qualified public assistance programs listed on Page 14.

• This form will be provided to you during the application process. You can also download a

copy of this document here.

• Please sign and submit a complete, legible scan or photo with all sections in green filled out.

• Your Application ID (beginning with a “P-“) can be found on your Application Account

Dashboard by clicking on your name in the upper right corner next to the "Logout" button.

Fill in all sections

in blue.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #6: Public Assistance Program Enrollment Document

(if applying for Rebate Plus via Enrollment in a Qualified Public Assistance Program)

Note: This document only needs to be submitted if applying for Rebate Plus and enrolled in one of the qualified

public assistance programs listed below.

Applicants enrolled in a qualifying state or federal program must submit a document

that, at a minimum, provides:

• Applicant name as the person receiving the benefit

• Name of the qualifying program (see list below)

• The government entity (state or tribal) or the managed care organization that issued the document

• An issue date within the last 12 months or a future expiration date beyond the date of application

submission.

• *Applicants with applications and supporting documents submitted on or after the eligible date listed on

the Program Requirements page

may qualify for Rebate Plus by providing their Drive Clean in the San

Joaquin Replace Program approval letter that confirms their verified household income is 80% or less of

the Area Median Income (AMI) for the applicant’s county.

• See Page 15 for details on acceptable Medi-Cal supporting documents.

Rebate Plus Qualifying State and Federal Programs

Bureau of Indian Affairs General Assistance: benefits.gov/benefit/801

CalFresh/SNAP (Food Stamps): benefits.gov/benefit/1228

Drive Clean in the San Joaquin Replace Program*: valleyair.org/drivecleaninthesanjoaquin/replace

CalWorks (TANF)/Tribal TANF:

benefits.gov/benefit/1229

benefits.gov/benefit/627

Head Start Income Eligible (Tribal Only): benefits.gov/benefit/1899

Low Income Housing Energy Assistance Program (LIHEAP): benefits.gov/benefit/1540

Medi-Cal (Income Qualified Medi-Cal Only): benefits.gov/benefit/1620

Medi-Cal for Families (Healthy Families A&B):

dhcs.ca.gov/services/Pages/Medi-CalPremiumPayments.aspx

Supplemental Security Income (SSI): benefits.gov/benefit/4412

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

benefits.gov/benefit/2041

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample J: Income-Qualified Medi-Cal Notice of Action Approval Letter

Note: This document only needs to be submitted if applying for Rebate Plus and you are enrolled in income-

qualified Medi-Cal.

Applicants submitting proof of enrollment for income-qualified Medi-Cal must provide the Notice of Action

Medi-Cal Approval Letter that confirms that their income was verified within 12 months of application

submission. We do not accept health insurance membership cards or benefit cards for this requirement.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample K: CalFresh/Food Stamps/SNAP Notice of Approval

Applicants submitting proof of enrollment for CalFresh must provide a notice that confirms they were either

approved or received benefits within 12 months of application submission. We do not accept benefits cards for

this requirement. A document that indicates an applicant’s enrollment in the program ended prior to vehicle

purchase will not be accepted.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Sample L: Low Income Home Energy Assistance Program (LIHEAP)

Applicants submitting proof of enrollment for LIHEAP must provide their completed CSD Form 43. Enrollment in

CARE/FERA cannot be used as proof of enrollment in LIHEAP.

Pre-Owned EV Rebate and Rebate Plus

Sample Supporting Documents

Document #7: PG&E Electric Bill

Sample M: PG&E Electric Bill "Energy Statement"

• During the application review process, you may be asked to submit a copy of your PG&E electric bill.

• If this is requested, please submit a recent copy of all pages of your PG&E Energy Statement displaying

your PG&E electric Service Agreement ID (XXXXXXXXXX), service address (matching your registration

address), and a date. The applicant’s name does not need to be listed as the account holder name on

your electric bill.

• The Energy Statement must show details for service that occurred at the time of application submission

or after.

• This information is typically found on page 3 of your bill in the section "Details of Electric Charges." Your

Service Agreement ID is not located on the first page of your statement and the full bill should be

submitted.

implemented and managed by the Center for Sustainable Energy and their authorized representatives. “PG&E” is a registered trademark of PG&E

Corporation. PG&E is not responsible for any other content, names or marks in these program materials. This program is funded by the California Air

Resource Board's Low Carbon Fuel Standard and is authorized through 2025 by the California Public Utilities Commission.