Form Vs-1074m - Vehicle Inspection Record Safety Motorcycle
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1
2Facility
Facility
Bureau of Consumer and Facility Services
Name
ID No.
VEHICLE INSPECTION RECORD
SAFETY MOTORCYCLE
Address - Street or Road
City
County
ZIP Code
(See instructions on other side)
1
2
3
4
5
6
7
8
9
10
11
12
Specify
Items Rejected
Enter serial number of
Year
Odometer Reading
Make
What
New York State
or Adjusted
Inspection Certificate if
Inspector’s
Tire
Date
of
(Indicate if
of
*
Brake is
(Codes from
Repair
vehicle passes, or
Certification
Pressure
Plate Number
Vehicle
(Month/Day/Year)
Broken or Missing)
Vehicle
Inspected
(Not a Rej.)
Column 12)
Order No.
“Rejected” if vehicle fails.
Number
Codes
/
/
1. Brakes
2. Steering/
Suspension/
Frame
3. Exhaust
4. Lights/
Reflectors
5. Tires
6. Horn
7. Mirrors
*If the vehicle does not have a plate, or displays a “Dealer” plate, enter the vehicle identification number (VIN) instead.
VS-1074M (10/15)
If it has an out-of-state plate, enter the state and plate number.
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Parent category: Legal