Form VP64 "Certificate of Inspection / Affidavit of Vehicle Construction" - Nevada

What Is Form VP64?

This is a legal form that was released by the Nevada Department of Motor Vehicles - a government authority operating within Nevada. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest edition provided by the Nevada Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form VP64 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

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Download Form VP64 "Certificate of Inspection / Affidavit of Vehicle Construction" - Nevada

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555 WRIGHT WAY
CARSON CITY, NV 89711-0700
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
www.dmvnv.com
CERTIFICATE OF INSPECTION / AFFIDAVIT OF VEHICLE CONSTRUCTION
NRS 482.223
 Manufactured Kit
Rebuilt Salvage
Reconstructed
Specially Constructed
A
-
NOT
-
VEHICLE LABELED FOR
OFF
ROAD USE ONLY
MAY
BE CONVERTED FOR ON
ROAD USE WITH THE
-
(
-254).
EXCEPTION OF AN OFF HIGHWAY TWO
WHEELED MOTORCYCLE
REFERENCE FORM VP
Instructions
• All parts of this form must be completed.
• A Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder must complete Part I.
• The vehicle owner must complete Part II and verify with a Nevada DMV Agency Representative or Notary Public.
• A Nevada DMV Agency Representative must complete Part III.
• A vehicle intended for “on-road” use by the manufacturer will be labeled stating FMVSS and EPA standards have been met.
• All inspection items must be checked “PASS,” indicating the item is in a safe operating condition before this vehicle can be registered
and/or titled.
• This form is not used for conversions. Reference Form VP-254 for an Off-Highway Two Wheeled Motorcycle Conversion Form.
• OWNERSHIP DOCUMENTS MUST ACCOMPANY THIS FORM
Important: A new form and inspection must be completed if any inspection items are marked fail, not marked, improperly
marked, or if corrections were made to the form.
PART I
SAFETY INSPECTION
Must be completed by a Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder
The work performed on the vehicle must meet the standards of the manufacturer for mechanical fitness and safety
__________________
_________________
________________
________________
Year
Make
Model
Type
Vehicle Identification Number (VIN)
Important: Adding the equipment listed below will not qualify a vehicle labeled by the
manufacturer for OFF-ROAD USE ONLY, to be registered for on-road use
Check (√) Appropriate Boxes
PASS
FAIL
N/A
PASS
FAIL
PASS
FAIL
N/A
Windshield
Headlights
Horn
Side Glass
Taillights
Muffler
Rear Glass
Turn Signals
Mudguards (over 26,000 lbs)
Mirrors
Parking Lights
Windshield Wipers
Steering
Brake Lights
Emergency Brake
Air Bags
Brakes
Safety Belts, Shoulder Harness
Frame
Other (explain) _______________________________________________________
Before signing below all items above must be marked “pass” indicating the items are in a safe operating condition. N/A may apply to air bags,
mudguards, reflectors and safety belts/shoulder harness only if the item was not original equipment. N/A may apply to glass and windshield if
not present; if present it must be proper safety glass.
Please Print or Type
___________________________________________________________________
Legal Business Name
Name
DMV Business License or Registration Number
Address____________________________________________________________________________________________
City
State
Zip Code
By signing this document, I certify the described motor vehicle is mechanically safe to operate and is equipped with all
required devices necessary for safe operation upon the highway. I further certify that if repaired, the passenger restraint
devices (as applicable), to include seat belts and/or airbags, were repaired pursuant to Title 49 CFR 571.209, Standard 209,
and Title 49 CFR 571.208, Standard 208, respectively, and have been satisfactorily repaired to the applicable standards of
the manufacturer and the motor vehicle repair industry.
_________________________________________
___________________________________________ ___________
Printed Full Legal Name of Affiant
Signature and Position
Date
VP-64 (Rev 12/2015) Signatures must be originals. Photocopies are not acceptable. Changes may not be made once it is notarized.
555 WRIGHT WAY
CARSON CITY, NV 89711-0700
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
www.dmvnv.com
CERTIFICATE OF INSPECTION / AFFIDAVIT OF VEHICLE CONSTRUCTION
NRS 482.223
 Manufactured Kit
Rebuilt Salvage
Reconstructed
Specially Constructed
A
-
NOT
-
VEHICLE LABELED FOR
OFF
ROAD USE ONLY
MAY
BE CONVERTED FOR ON
ROAD USE WITH THE
-
(
-254).
EXCEPTION OF AN OFF HIGHWAY TWO
WHEELED MOTORCYCLE
REFERENCE FORM VP
Instructions
• All parts of this form must be completed.
• A Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder must complete Part I.
• The vehicle owner must complete Part II and verify with a Nevada DMV Agency Representative or Notary Public.
• A Nevada DMV Agency Representative must complete Part III.
• A vehicle intended for “on-road” use by the manufacturer will be labeled stating FMVSS and EPA standards have been met.
• All inspection items must be checked “PASS,” indicating the item is in a safe operating condition before this vehicle can be registered
and/or titled.
• This form is not used for conversions. Reference Form VP-254 for an Off-Highway Two Wheeled Motorcycle Conversion Form.
• OWNERSHIP DOCUMENTS MUST ACCOMPANY THIS FORM
Important: A new form and inspection must be completed if any inspection items are marked fail, not marked, improperly
marked, or if corrections were made to the form.
PART I
SAFETY INSPECTION
Must be completed by a Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder
The work performed on the vehicle must meet the standards of the manufacturer for mechanical fitness and safety
__________________
_________________
________________
________________
Year
Make
Model
Type
Vehicle Identification Number (VIN)
Important: Adding the equipment listed below will not qualify a vehicle labeled by the
manufacturer for OFF-ROAD USE ONLY, to be registered for on-road use
Check (√) Appropriate Boxes
PASS
FAIL
N/A
PASS
FAIL
PASS
FAIL
N/A
Windshield
Headlights
Horn
Side Glass
Taillights
Muffler
Rear Glass
Turn Signals
Mudguards (over 26,000 lbs)
Mirrors
Parking Lights
Windshield Wipers
Steering
Brake Lights
Emergency Brake
Air Bags
Brakes
Safety Belts, Shoulder Harness
Frame
Other (explain) _______________________________________________________
Before signing below all items above must be marked “pass” indicating the items are in a safe operating condition. N/A may apply to air bags,
mudguards, reflectors and safety belts/shoulder harness only if the item was not original equipment. N/A may apply to glass and windshield if
not present; if present it must be proper safety glass.
Please Print or Type
___________________________________________________________________
Legal Business Name
Name
DMV Business License or Registration Number
Address____________________________________________________________________________________________
City
State
Zip Code
By signing this document, I certify the described motor vehicle is mechanically safe to operate and is equipped with all
required devices necessary for safe operation upon the highway. I further certify that if repaired, the passenger restraint
devices (as applicable), to include seat belts and/or airbags, were repaired pursuant to Title 49 CFR 571.209, Standard 209,
and Title 49 CFR 571.208, Standard 208, respectively, and have been satisfactorily repaired to the applicable standards of
the manufacturer and the motor vehicle repair industry.
_________________________________________
___________________________________________ ___________
Printed Full Legal Name of Affiant
Signature and Position
Date
VP-64 (Rev 12/2015) Signatures must be originals. Photocopies are not acceptable. Changes may not be made once it is notarized.
PART II
AFFIDAVIT OF CONSTRUCTION FOR REBUILT SALVAGE, RECONSTRUCTED
AND SPECIALLY CONSTRUCTED VEHICLES
The undersigned, being duly sworn upon oath, deposes and says they are the owner of the vehicle listed below. This
vehicle was rebuilt or built from parts and materials on hand, or parts and materials purchased from a supplier, or a
manufactured kit purchased from a supplier, or purchased “as is” from a rebuilder, or otherwise lawfully acquired. The
affiant or registered owner makes this affidavit as part of an application to the Nevada Department of Motor Vehicles for a
Certificate of Registration and/or a Certificate of Title. The undersigned will indemnify and hold harmless the State of
Nevada on account of the issuance of a Certificate of Registration and/or Certificate of Title for said vehicle.
Vehicle was constructed from parts/material on hand
Vehicle was assembled from manufactured kit
Vehicle was built from purchased parts/material, receipts attached
Vehicle was purchased “as is” from rebuilder
Please Print or Type
_________ ____________________________________ ___________________ ____________________ __________
Year
Make (if a manufactured kit)
Model
Type
No. of axles
Affiant’s Full Legal Name
(As appears on Driver’s License or ID)
First
Middle
Last
Driver’s License, ID Number or DOB
Telephone Number
Affiant’s Physical Address
Street
City
State
Zip Code
Affiant’s Mailing Address
Street
City
State
Zip Code
State of Nevada, County of
signed and sworn to (or affirmed) before me on,
by,
Date
Signature of Affiant
Signature of Notary Public or Authorized DMV Representative
Authorized DMV Representative ID Number
Notary Stamp
PART III
COMPLETED BY AN AUTHORIZED NEVADA DMV REPRESENTATIVE
Note: Attach copies of any title or purchase documents, supplied by owner, showing information of components used from other vehicles.
VIN & Part ________________________________________ VIN & Part________________________________________
VIN & Part ________________________________________ VIN & Part________________________________________
VIN indicated in Part I Verified
Vehicle Inspection Fee
DMV Assigned VIN or Kit Manufacturer’s VIN
VIN Assignment Fee
Different than listed in Part I Year________ Make______________ Model_____________ Type___________________
Reason VIN assigned ________________________________________________________________________________
Odometer Reading (as shown on apparatus)
NO TENTHS
If the vehicle’s odometer apparatus only displays five numbers, please put an X in the first box.
 1. The mileage stated is in excess of its mechanical limits.
 2. The odometer reading is not the actual mileage. WARNING – ODOMETER DISCREPANCY
 3. Exempt – Model year over 9 years old.
 This vehicle was restored prior to authorization. The undersigned is authorizing restoration after the fact on this form in
lieu of form VP-209.
Additional comments: ________________________________________________________________________________
________________________________ ______________________________ ______ ___________
Printed Name of Nevada DMV Agency Representative
Signature of Nevada DMV Agency Representative
ID NO.
Date
VP-64 (Rev 12/2015) Signatures must be originals. Photocopies are not acceptable. Changes may not be made once it is notarized.
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