"Letter of Verification" - Nebraska

Letter of Verification is a legal document that was released by the Nebraska Department of Motor Vehicles - a government authority operating within Nebraska.

Form Details:

  • The latest edition currently provided by the Nebraska Department of Motor Vehicles;
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  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Motor Vehicles.

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Letter must be printed on insurance company or agency letterhead
DEPARTMENT OF MOTOR VEHICLES
Date
FINANCIAL RESPONSIBILITY DIVISION
PO BOX 94877
LINCOLN NE 68509-4877
Letter of Verification for:
Name of Driver:
Date of Birth:
Street Address:
City, State, Zip:
Vehicle Description:
Year:
Make:
Model:
VIN:
The purpose of this letter is to confirm liability insurance coverage with the Department of Motor Vehicles for the above
captioned driver. The records of the insurance company indicate coverage as follows:
Name of Insurance Company:
Policy Number:
Policy Holder:
Yes
No
Permissible Driver:
Select Applicable:
The insurance information listed above provided liability coverage for the driver for the accident (for all damage and/or
injuries incurred
The insurance information listed above provided liability coverage for the driver for the citation for No Proof of Insurance
Accident date / citation date:
AFTER PRINTING - DO NOT FORGET TO SIGN THE FORM AND INCLUDE YOUR POSITION TITLE BELOW
Signature (required):
Title of position (required):
Print Form
Letter must be printed on insurance company or agency letterhead
DEPARTMENT OF MOTOR VEHICLES
Date
FINANCIAL RESPONSIBILITY DIVISION
PO BOX 94877
LINCOLN NE 68509-4877
Letter of Verification for:
Name of Driver:
Date of Birth:
Street Address:
City, State, Zip:
Vehicle Description:
Year:
Make:
Model:
VIN:
The purpose of this letter is to confirm liability insurance coverage with the Department of Motor Vehicles for the above
captioned driver. The records of the insurance company indicate coverage as follows:
Name of Insurance Company:
Policy Number:
Policy Holder:
Yes
No
Permissible Driver:
Select Applicable:
The insurance information listed above provided liability coverage for the driver for the accident (for all damage and/or
injuries incurred
The insurance information listed above provided liability coverage for the driver for the citation for No Proof of Insurance
Accident date / citation date:
AFTER PRINTING - DO NOT FORGET TO SIGN THE FORM AND INCLUDE YOUR POSITION TITLE BELOW
Signature (required):
Title of position (required):