Form Vp-64 - Certificate Of Inspection / Affidavit Of Vehicle Construction printable pdf download

555 WRIGHT WAY

CARSON CITY, NV 89711-0700

Reno/Sparks/Carson City (775) 684-4DMV (4368)

Las Vegas Area (702) 486-4DMV (4368)

Rural Nevada or Out of State (877) 368-7828

CERTIFICATE OF INSPECTION / AFFIDAVIT OF VEHICLE CONSTRUCTION

NRS 482.223

Manufactured Kit

Rebuilt Salvage

Reconstructed

Specially Constructed

“

”

NOT

VEHICLE LABELED FOR

OFF

ROAD USE ONLY

MAY

BE CONVERTED FOR ON

ROAD USE WITH THE

(

-254).

EXCEPTION OF AN OFF HIGHWAY TWO

WHEELED MOTORCYCLE

REFERENCE FORM VP

Instructions

• All parts of this form must be completed.

• A Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder must complete Part I.

• The vehicle owner must complete Part II and verify with a Nevada DMV Agency Representative or Notary Public.

• A Nevada DMV Agency Representative must complete Part III.

• A vehicle intended for “on-road” use by the manufacturer will be labeled stating FMVSS and EPA standards have been met.

• All inspection items must be checked “PASS,” indicating the item is in a safe operating condition before this vehicle can be registered

and/or titled.

• This form is not used for conversions. Reference Form VP-254 for an Off-Highway Two Wheeled Motorcycle Conversion Form.

• OWNERSHIP DOCUMENTS MUST ACCOMPANY THIS FORM

Important: A new form and inspection must be completed if any inspection items are marked fail, not marked, improperly

marked, or if corrections were made to the form.

PART I

SAFETY INSPECTION

Must be completed by a Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder

The work performed on the vehicle must meet the standards of the manufacturer for mechanical fitness and safety

__________________

_________________

________________

Year

Make

Model

Type

Vehicle Identification Number (VIN)

Important: Adding the equipment listed below will not qualify a vehicle labeled by the

manufacturer for OFF-ROAD USE ONLY, to be registered for on-road use

Check (√) Appropriate Boxes

PASS

FAIL

N/A

PASS

FAIL

PASS

FAIL

N/A

Windshield

Headlights

Horn

Side Glass

Taillights

Muffler

Rear Glass

Turn Signals

Mudguards (over 26,000 lbs)

Mirrors

Parking Lights

Windshield Wipers

Steering

Brake Lights

Emergency Brake

Air Bags

Brakes

Safety Belts, Shoulder Harness

Frame

Other (explain) _______________________________________________________

Before signing below all items above must be marked “pass” indicating the items are in a safe operating condition. N/A may apply to air bags,

mudguards, reflectors and safety belts/shoulder harness only if the item was not original equipment. N/A may apply to glass and windshield if

not present; if present it must be proper safety glass.

Please Print or Type

___________________________________________________________________

Legal Business Name

Name

DMV Business License or Registration Number

Address____________________________________________________________________________________________

City

State

Zip Code

By signing this document, I certify the described motor vehicle is mechanically safe to operate and is equipped with all

required devices necessary for safe operation upon the highway. I further certify that if repaired, the passenger restraint

devices (as applicable), to include seat belts and/or airbags, were repaired pursuant to Title 49 CFR 571.209, Standard 209,

and Title 49 CFR 571.208, Standard 208, respectively, and have been satisfactorily repaired to the applicable standards of

the manufacturer and the motor vehicle repair industry.

_________________________________________

___________________________________________ ___________

Printed Full Legal Name of Affiant

Signature and Position

Date

VP-64 (Rev 6/2011)

Form Vp-64 - Certificate Of Inspection / Affidavit Of Vehicle Construction

Related Articles

Related forms

Related Categories