Form Ps2015a-14 - Declaration Of Reconstruction/special Assembly Page 2
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5DECLARATION OF RECONSTRUCTION/SPECIAL ASSEMBLY
Side B- Motorcycles
This declaration must accompany the application to title your reconstructed or specially assembled motorcycle. Original titles,
manufacturer's certificates of origin and/or receipts for all major parts used in the construction must accompany this declaration. Please
refer to the Guide For Reconstructed Vehicles for minimum proof of ownership requirements. If you are doing a reconstruction that
would require the removal of a vehicle identification number (VIN), such as cutting the neck piece for a custom rake, you must contact
the Inspection Unit at (651) 282-2173 before beginning the reconstruction.
Current License Plate Number:
Current Title Number:
Part
Part Number/VIN of Parts Vehicle
Obtained From
Frame
Engine
Engine Cases
Note: If the engine was not purchased as
a complete assembly, receipts for motor
parts and cases required.
Transmission
Note: If the transmission was not
purchased as a complete assembly,
receipts for transmission parts and cases
are required.
Fork Assembly
Front Wheel Assembly
Rear Wheel Assembly
Other Changes:
Describe fully any other changes such as cutting down the body or frame, changes of springs, wheels, axles, etc.
The person who made the repairs must sign this form.
Important: Minnesota Statute 168A.30 provides that falsifying information on any required document shall be guilty of a felony.
This serves as written confirmation to the Department of Public Safety that the vehicle to be titled meets the requirements of M.S. Chapter
169 for vehicles in its class regarding safety and acceptability to operate on public roads and highways.
Owner’s Name
Repair Shop Name/Phone
X
Assembler’s/Rebuilder’s Signature
- over -
PS2015A-14 (07/15)
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