Inv 26-3 - Application For Alabama Assigned Vehicle Identification Number
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1
2A
D
R
LABAMA
EPARTMENT OF
EVENUE
INV 26-3
M
V
D
2/17
OTOR
EHICLE
IVISION
I
S
NSPECTIONS
ECTION
P.O. Box 327641 • Montgomery, AL 36132-7641 • (334) 242-9000
Application For Alabama Assigned
Vehicle Identification Number
TYPE OR PRINT AND MAIL COMPLETED FORM TO THE ABOVE ADDRESS • SEE REVERSE SIDE FOR INSTRUCTIONS
SECTION A
Application is hereby made for an Alabama Assigned Vehicle Identification Number for the vehicle described hereon by reason of:
Altered
Removed
Obliterated
Defaced
Missing
Omitted
Rebuilt
Assembled
SECTION B — VEHICLE INFORMATION
PREVIOUS VEHICLE IDENTIFICATION NUMBER
MAKE
YEAR
MODEL
BODY TYPE
COLOR
ODOMETER READING
NO. CYLINDERS
PREVIOUS TITLE NUMBER
TITLE STATE
NEW
USED
DATE OF PURCHASE
NO. LIENS
SECTION C — OWNER INFORMATION
NAME
WORK PHONE
HOME PHONE
( )
( )
MAILING ADDRESS
CITY
STATE
ZIP
SECTION D — LIENHOLDER INFORMATION
NAME
LIEN DATE
MAILING ADDRESS
CITY
STATE
ZIP
NOTE: If more than one lienholder, list them on a separate sheet of paper and attach to this form.
SECTION E — FOR REBUILT AND / OR ASSEMBLED VEHICLE ONLY
The above vehicle was rebuilt/assembled by ________________________________________________________________________
whose address is _____________________________________________________________________________________________
and completed on the __________ day of __________________________, _________.
SECTION F — LOCATION OF VEHICLE FOR INSPECTION PURPOSES
SECTION G
I (we) certify that I (we) are the legal and rightful owner(s) of the vehicle described above. I (we) further certify that this vehicle is free
and clear of all debt, except as indicated above and that all information contained in this application is true and correct.
________________________________________________________
SIGNATURE OF OWNER(S)
DATE
_________
_________________________
_____
Subscribed to and Sworn before me this
day of
, ____
.
c ________________________________________________________
Notary Publi
SIGNATURE OF NOTARY
My Commission Expires _________________________, ________.
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