Form Mvd-11268 - Affidavit Of Non-Use Of Vehicle Or Affidavit Of Out-Of-State Vehicle Insurance - State Of New Mexico - Motor Vehicle Division

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MVD-11268
STATE OF NEW MEXICO – MOTOR VEHICLE DIVISION
REV. 10/06
AFFIDAVIT OF NON-USE OF VEHICLE
OR
AFFIDAVIT OF OUT-OF-STATE VEHICLE INSURANCE
OWNER INFORMATION
MANDATORY
NAME________________________________________________________________________________________________________
LAST
FIRST
MI
ADDRESS_____________________________________________________________________________________________________
CITY_______________________________ STATE__________ ZIP______________________ PHONE #________________________
DATE OF BIRTH ________________________DRIVER LICENSE NUMBER and STATE ______________________________________
VEHICLE INFORMATION
MANDATORY
MAKE ____________________________MODEL __________________________________YEAR ______________________________
VIN ______________________________________________________________________PLATE NO.___________________________
NON-USE INFORMATION
OPTION 1
(Please Initial Box)
The vehicle is not being operated for any reason including but not limited to:
MILITARY DEPLOYMENT,
Please enter anticipated NON-USE dates below:
MECHANICAL ISSUES, and STORAGE OR SEASONAL USAGE.
FROM__________________________________________TO_____________________________________________
** The NON-USE portion of the affidavit is only valid for a maximum of ONE YEAR.
** A new affidavit MUST be completed each year that the vehicle will not be driven.
OUT-OF-STATE INFORMATION
OPTION 2
MANDATORY LIABILITY LIMITS § 66-5-208:
$25,000 Bodily Injury per one person in one accident.
$50,000 Bodily Injury per additional one person in one accident.
$10,000 Destruction of property of others in any one accident.
(Please Initial Box)
I CURRENTLY HAVE INSURANCE COVERAGE IN COMPLAINCE WITH THE NEW MEXICO MANDATORY FINANCIAL
RESPONSIBILITY ACT § 66-5-201 thru 66-5-239.
INSURANCE COMPANY_______________________________________POLICY #________________________________________
PHONE #_________________________________________ EFFECTIVE DATES___________________TO____________________
NOTE: YOU MUST ATTACH A COPY OF A CURRENT INSURANCE CARD AND DECLARATION PAGE CONTAINING LIABILITY LIMITS.
** The OUT-OF-STATE portion of the affidavit is only valid during the effective dates of your insurance policy.
** A new affidavit MUST be completed each time the policy renews.
AFFIRMATION
MANDATORY
I SWEAR OR AFFIRM UNDER PENALTY OF PERJURY THAT THE ABOVE STATEMENTS ARE TRUE AND CORRECT:
PRINTED NAME__________________________________________________________________________________________
SIGNATURE________________________________________________________DATE_________________________________
An affidavit must be completed every time a vehicle status changes or at the minimum, annually.
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Vehicles registered and operated in New Mexico MUST have insurance coverage meeting the minimum liability requirements
of the New Mexico Mandatory Financial Responsibility Act § 66-5-201 thru 66-5-239.
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You may receive a letter from the (IIDB) requiring insurance compliance with the Mandatory Financial Responsibility Act.
If you receive a letter please call the IIDB at the number listed below.
Please return COMPLETED affidavit and ALL required documentation to the New Mexico Insurance Identification Database (IIDB).
OR
MAIL TO:
PO BOX 9700
FAX TO: 1-505-243-6605
ALBUQUERQUE, NM 87119-9700
For more information please call the IIDB toll free at 1-866-891-0665.

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