Affidavit Of Reconstruction/special Assembly printable pdf download

Affidavit Of Reconstruction/special Assembly

MINNESOTA DEPARTMENT OF PUBLIC SAFETY

DRIVER AND VEHICLE S ERVICES DIVISION

445 MINNESOTA ST.

ST. PAUL, MN 55101

651-296-6911

AFFIDAVIT OF RECONSTRUCTION/SPECIAL ASSEMBLY

It is against Federal and State laws to tamper with or remove a vehicle identification number (VIN) plate or label. Destruction,

removal, alteration, covering, or defacement of the original vehicle identification number may be cause for the Department to refuse to

title or register your vehicle. Reconstructed and specially assembled vehicles are subject to a motor vehicle inspection.

Side A - Cars/Trucks/Pickups

This affidavit must accompany the application to title your reconstructed or specially assembled vehicle. Original titles,

manufacturer's certificates of origin and/or receipts for all major parts used in the reconstruction must accompany this affidavit.

Please refer to the Guide for Reconstructed Vehicles for minimum proof of ownership requirements.

Current License Plate Number: ___________________

Current Title Number: ___________________________

Part

Part Number/VIN of Parts Vehicle

Obtained From

Body

Cab

Frame

Chassis

Doors

Fender

Bumper

Quarter Panel

Front End Assembly

Rear Clip

Engine

Transmission

Hood

Roof

Other Changes:

Describe fully any other changes such as cutting down the body or frame, changes of springs, wheels, axles, etc.

Subscribed and sworn to me before this

day of

Repair Shop Name/Phone

Notary Public’s Signature

Assembler’s/Rebuilder’s Signature

Notary Public County of

Owner’s Name

My Commission Expires:

PS2015A-09

Affidavit Of Reconstruction/special Assembly