Form Mvr-58 - Affidavit Of Facts For The Registration Of A Moped
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1MVR-58
(Rev. 07/15)
North Carolina Division of Motor Vehicles
AFFIDAVIT OF FACTS FOR THE REGISTRATION OF A MOPED
North Carolina General Statute 105-164.3 (22) defines a moped as, "A vehicle that has two or three wheels, no external
shifting device, and a motor that does not exceed 50 cubic centimeters piston displacement and cannot propel the vehicle
at a speed greater than 30 miles per hour on a level surface".
Instructions: The following questions must be answered in detail and this form must be presented as an application for the
registration of a moped for which a Manufacturer's Certificate of Origin cannot be furnished. Furnish any documents in your
possession that will show proof of ownership. Examples include titles, bill of sale, conditional sales contract, invoices, or out
of state registrations.
A valid North Carolina Driver License or North Carolina ID Card must be presented when applying for registration.
VEHICLE SECTION
YEAR
MAKE
BODY STYLE
VEHICLE IDENTIFICATION NUMBER*
MOPED
OWNER SECTION
OWNER 1 ID #
FULL LEGAL NAME OF OWNER
OWNER 2 ID #
FULL LEGAL NAME OF OWNER
STREET ADDRESS
CITY
STATE
ZIP CODE
COUNTY
MAILING ADDRESS IF DIFFERENT FROM ABOVE
VEHICLE LOCATION IF DIFFERENT FROM ABOVE
1. I attest to the following: (Must Initial)
(a) This vehicle has two or three wheels, no external shifting device and a motor that does not exceed 50 cubic centimeters piston
displacement. ____________(owner's initials)
(b) This vehicle cannot propel at a speed greater than 30 miles per hour on a level surface. ______________ (owner's initials)
2. I am the true and legal owner of the above described moped. I acquired the vehicle on or about __________________, 20 ___________
3. From whom did you purchase this vehicle? (check one):
Private Party (Individual) - Name ___________________________________ Address ________________________________________
Business - Name __________________________________________ Address ______________________________________________
4. I do not have a Manufacturer's Certificate of Origin because (check one):
One was not provided to me by the dealer at the time of purchase; or
Moped was purchased used from individual
Other (explain): _______________________________________________________________________________________________
I affirm under penalty of perjury and/or punishment pursuant to N.C.G.S. 20-112, that the foregoing information is based upon my
personal knowledge and is true and accurate to the best of my knowledge.
Signature of Owner(s) ______________________________________________________________________________________________
Date _____________________ County ________________________________
State _________________________________________
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the
foregoing document for the purpose stated herein and in the capacity indicated:
___________________________________________________________________________________________(name(s) of principal(s) ).
Notary
Notary Printed
or Typed Name _________________________________________
Signature _______________________________________________
(SEAL)
My Commission Expires ____________________________________
*If the VIN cannot be located, you will need to contact your local NCDMV License & Theft Inspector.
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