Form Ta-Vt-10 (D) - Verification Of Motor Vehicle Vessel Atv Snowmobile Identification Number Statement

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Verification of Motor Vehicle/Vessel/ATV/Snowmobile
Identification Number Statement
DEPARTMENT OF MOTOR VEHICLES
120 State Street
Agency of Transportation
Montpelier, Vermont 05603-0001
dmv.vermont.gov
Phone: 802.828.2000 ~ Toll Free: 888-998-3766 ~ TTD: 711
Please refer to the instructions on the back of this form.
SECTION 1:
TO BE COMPLETED BY THE APPLICANT.
Current Owner's Name
Mailing Address - Street, Box, RD
Daytime Phone
(Include Area Code)
(
)
City, State & Zip Code
Evening Phone
(Include Area Code)
(
)
Email Address
Make
Model
Year
Body/Hull Type
Vessel Length
(YYYY)
Ft.
In.
Current Registration Number (if applicable):
Title Number
Is this a Salvage Motor Vehicle/
Meter Reading
Vessel/ATV/Snowmobile
Actual numeric reading as shown on odometer (no tenths)
 Yes
 No
 Miles  Kilometers  Hours
SECTION 2:
TO BE COMPLETED BY AUTHORIZED PERSONNEL ONLY
(See Section 3 of the instructions.)
~
I have examined the motor vehicle/vessel/ATV/snowmobile described above and certify that the motor vehicle/vessel/ATV/snowmobile
identification number is as stated and shows no sign of alteration.
Motor Vehicle/Vessel/ATV/Snowmobile Identification (Serial) Number
NOTE: The serial number must be entered in the space below by the verifying official.
Presently Registered In The State Of
Date
(MM/DD/YYYY)
-
-
At Town or City
State
I attest I have been certified to visually verify Vehicle Identification Numbers. I certify that the statements herein are true.
This declaration is made under penalties of 23 VSA §202 and §203.
Authorized Signature
Phone Number
(Include Area Code)
(
)
VINASSIST  Yes  No
Organization
Badge / ID # or Rater #
 Yes  No
NCIC
Meter Reading
THIS VERIFICATION IS VOID IF ALTERED OR
Actual numeric reading as shown on odometer (no tenths)
TAMPERED WITH IN ANY MANNER.
Miles
Kilometers
Hours
TA-VT-10 (d) 10M 10/2013 REB

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