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MVD-11268

STATE OF NEW MEXICO – MOTOR VEHICLE DIVISION

REV. 10/06

AFFIDAVIT OF NON-USE OF VEHICLE

AFFIDAVIT OF OUT-OF-STATE VEHICLE INSURANCE

OWNER INFORMATION

MANDATORY

NAME________________________________________________________________________________________________________

LAST

FIRST

ADDRESS_____________________________________________________________________________________________________

CITY_______________________________ STATE__________ ZIP______________________ PHONE #________________________

DATE OF BIRTH ________________________DRIVER LICENSE NUMBER and STATE ______________________________________

VEHICLE INFORMATION

MANDATORY

MAKE ____________________________MODEL __________________________________YEAR ______________________________

VIN ______________________________________________________________________PLATE NO.___________________________

NON-USE INFORMATION

OPTION 1

(Please Initial Box)

The vehicle is not being operated for any reason including but not limited to:

MILITARY DEPLOYMENT,

Please enter anticipated NON-USE dates below:

MECHANICAL ISSUES, and STORAGE OR SEASONAL USAGE.

FROM__________________________________________TO_____________________________________________

** The NON-USE portion of the affidavit is only valid for a maximum of ONE YEAR.

** A new affidavit MUST be completed each year that the vehicle will not be driven.

OUT-OF-STATE INFORMATION

OPTION 2

MANDATORY LIABILITY LIMITS § 66-5-208:

$25,000 Bodily Injury per one person in one accident.

$50,000 Bodily Injury per additional one person in one accident.

$10,000 Destruction of property of others in any one accident.

(Please Initial Box)

I CURRENTLY HAVE INSURANCE COVERAGE IN COMPLAINCE WITH THE NEW MEXICO MANDATORY FINANCIAL

RESPONSIBILITY ACT § 66-5-201 thru 66-5-239.

INSURANCE COMPANY_______________________________________POLICY #________________________________________

PHONE #_________________________________________ EFFECTIVE DATES___________________TO____________________

NOTE: YOU MUST ATTACH A COPY OF A CURRENT INSURANCE CARD AND DECLARATION PAGE CONTAINING LIABILITY LIMITS.

** The OUT-OF-STATE portion of the affidavit is only valid during the effective dates of your insurance policy.

** A new affidavit MUST be completed each time the policy renews.

AFFIRMATION

MANDATORY

I SWEAR OR AFFIRM UNDER PENALTY OF PERJURY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT:

PRINTED NAME__________________________________________________________________________________________

SIGNATURE________________________________________________________DATE_________________________________

An affidavit must be completed every time a vehicle status changes or at the minimum, annually.

Vehicles registered and operated in New Mexico MUST have insurance coverage meeting the minimum liability requirements

of the New Mexico Mandatory Financial Responsibility Act § 66-5-201 thru 66-5-239.

You may receive a letter from the (IIDB) requiring insurance compliance with the Mandatory Financial Responsibility Act.

If you receive a letter please call the IIDB at the number listed below.

Please return COMPLETED affidavit and ALL required documentation to the New Mexico Insurance Identification Database (IIDB).

MAIL TO:

PO BOX 9700

FAX TO: 1-505-243-6605

ALBUQUERQUE, NM 87119-9700

For more information please call the IIDB toll free at 1-866-891-0665.

Form Mvd-11268 - Affidavit Of Non-Use Of Vehicle Or Affidavit Of Out-Of-State Vehicle Insurance - State Of New Mexico - Motor Vehicle Division

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