Verification Of Vehicle Identification

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State of New Hampshire
Department of Safety
Division of Motor Vehicles
Bureau of Title and Anti-Theft
John J. Barthelmes
Concord, N.H. 03305 (603) 227-4150
Commissioner of Safety
Director of Motor Vehicles
VERIFICATION OF VEHICLE IDENTIFICATION
This is to certify that I have physically examined at
, N.H., the vehicle described herein:
Location
Year
Make
Model
Body Style
Owner’s Reg. No.
and found the vehicle identification number to be
The vehicle identification number appears to be
Altered
Changed
Missing
Owner of Vehicle
Address
I further certify that the above referred to Vehicle Identification Number was not obtained from any registration or documents relative to this
vehicle and was obtained by a visual inspection of the Public V.I.N. Plate.
By
Date
Agent’s Signature
This application is signed under penalty of unsworn falsification
This form may only be completed by:
pursuant to RSA 641:3.
New Hampshire Law Enforcement Officer
Badge #
Agency
Authorized N.H. Licensed Auto Dealer
Plate #
Address
Authorized N.H. Inspection Station #
Tel. No.
TDMV 19A (Rev. 07/11)

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