Form Vs-1075.3 - Requisition For Miscellaneous Forms
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1REQUISITION FOR MISCELLANEOUS FORMS
Bureau of Consumer and Facility Services
PO Box 2700
Albany NY 12220-0700
April 19, 2016
Date:
QUANTITY
FORM NO.
NAME OF FORM
REQUESTED
VS-18
Statement That A Historical Registered Vehicle Will Be Used During Daylight Hours Only
VS-110*
Notice of Missing or Mutilated Vehicle Identification No.
VS-1074SD
Vehicle Inspection Record - Heavy Vehicle Safety & Diesel Emissions
VS-1074M
Vehicle Inspection Record - Motorcycle Safety
Vehicle Inspection Record - Safety
VS-1074S
Inspection Rejection/Advisory Notice
VS-1075*
VS-1075.3
Requisition for Miscellaneous Forms
VS-1079DE
Diesel Emissions Inspection Certification and Waiver Form
VS-1080R
Proof of HDDV Repair
* These forms are bound in pads of 100 sheets per pad. Order by number of pads needed.
PLEASE TYPE OR PRINT LEGIBLY AND INCLUDE YOUR SEVEN-DIGIT FACILITY NUMBER. WE WILL NOT PROCESS
YOUR ORDER WITHOUT IT.
Facility ID
Name of Official
Number
Inspection Station
Address
City
State
Zip Code
IMPORTANT:
l
Please mail this requisition separately.
l
Do not attach it to any other forms before mailing.
l
Allow 3-4 weeks for delivery.
dmv.ny.gov
VS-1075.3 (9/15)
reset/clear
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