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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 MOTORCYCLE/TRIMOBILE CONSTRUCTION

NRS 482.223

 Manufactured Kit



Rebuilt Salvage



Reconstructed



Specially Constructed

THIS FORM IS NOT INTENDED FOR USE AS AN OFF

HIGHWAY TWO WHEELED MOTORCYCLE

. U

VP-254

CONVERSION FORM

SE FORM

FOR MOTORCYCLE CONVERSIONS

Instructions

 All parts of this form must be completed.

 A Nevada Registered Garage, Motorcycle Repair Shop, 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 motorcycle intended for “on-road use” by the manufacturer will have a label or labels attached 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 motorcycle can be

registered and/or titled

 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 Motorcycle Repair Shop, 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: This is not a conversion form. Reference Form VP-254 for motorcycle conversion information

Check () Appropriate Boxes

N/A (Turn Signals) is only for motorcycles built prior to January 1, 1973, not originally equipped with turn signals.

PASS

FAIL

N/A

PASS

FAIL

PASS

FAIL

Horn

Reflectors

Brake Light



Headlight(s)

Taillight

Fenders



Turn Signals

Muffler(s)

Mirrors



Frame

DOT Legal Tires

Brakes



Before signing below all items above must be marked “pass” indicating the items are installed per NRS and in a safe operating condition.

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 motorcycle 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, all safety devices 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-64M (Rev. 8/2012)

Signatures must be originals. Photocopies are not acceptable. Changes may not be made once it is notarized.

Form Vp-64m - Certificate Of Inspection / Affidavit Of Motorcycle/trimobile Construction

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