Form VSC104 "Massachusetts Vehicle Check Inspector License" - Massachusetts

What Is Form VSC104?

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

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the Massachusetts Registry 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 VSC104 by clicking the link below or browse more documents and templates provided by the Massachusetts Registry of Motor Vehicles.

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Download Form VSC104 "Massachusetts Vehicle Check Inspector License" - Massachusetts

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Massachusetts Vehicle Check Inspector License
Save time, go to mass.gov/RMV to apply online!
Registry of Motor Vehicles ● Vehicle Safety & Compliance Services
P.O. Box 55892 ● Boston MA 02205-5892
Application Fee: $25.00
A. Applicant Information
Last Name
First Name
Middle Name
Suffix
Driver’s License #
State of Issue
If Out-of-State Applicant, Social Security #
Date of Birth (MM/DD/YYYY)
/
/
Daytime Phone #
License Class
Issue Date (MM/DD/YYYY)
Expiration Date (MM/DD/YYYY)
/
/
/
/
Residential Address
Street
Apt. #
City
State
Zip Code
 (same as above)
Mailing Address
Street
Apt. #
State
Zip Code
City
Email
B. Required Information
1. You must have a valid driver’s license for the class of vehicle you will be inspecting with a state assigned license number.
2. Out-of-state applicants are required to submit a copy of the front and back of their current their drivers license.
3. You must complete, sign and submit this application form before requesting training. UNSIGNED FORMS WILL BE RETURNED.
4. Complete application and mail check or money order ($25 fee) payable to MassDOT to:
The Registry of Motor Vehicles, Vehicle Safety & Compliance Services
P.O. Box 55892, Boston, MA 02205-5892
5.
Contact Applus Technologies, Inc. to schedule training.
C. Certification and Signature of Applicant
(application not complete without signature)
Final approval is dependent upon successful completion of inspector training. For further training information,
contact Applus Technologies at 1-844-358-0135.
Out-of-state applications must send a copy of their valid driver license from issuing state and will be processed through the National
Driver Register (NDR) and/or the Commercial Driver License Information System (CDLIS) to verify the status of operating privileges
in other jurisdictions. I, the undersigned, hereby apply for a license to inspect motor vehicles and swear (affirm), under the penalties
of perjury, that the information I have provided in this application is true and correct.
Signature: ________________________________________________________________ Date: ___________________________
p.1
VSC104_0218
Massachusetts Vehicle Check Inspector License
Save time, go to mass.gov/RMV to apply online!
Registry of Motor Vehicles ● Vehicle Safety & Compliance Services
P.O. Box 55892 ● Boston MA 02205-5892
Application Fee: $25.00
A. Applicant Information
Last Name
First Name
Middle Name
Suffix
Driver’s License #
State of Issue
If Out-of-State Applicant, Social Security #
Date of Birth (MM/DD/YYYY)
/
/
Daytime Phone #
License Class
Issue Date (MM/DD/YYYY)
Expiration Date (MM/DD/YYYY)
/
/
/
/
Residential Address
Street
Apt. #
City
State
Zip Code
 (same as above)
Mailing Address
Street
Apt. #
State
Zip Code
City
Email
B. Required Information
1. You must have a valid driver’s license for the class of vehicle you will be inspecting with a state assigned license number.
2. Out-of-state applicants are required to submit a copy of the front and back of their current their drivers license.
3. You must complete, sign and submit this application form before requesting training. UNSIGNED FORMS WILL BE RETURNED.
4. Complete application and mail check or money order ($25 fee) payable to MassDOT to:
The Registry of Motor Vehicles, Vehicle Safety & Compliance Services
P.O. Box 55892, Boston, MA 02205-5892
5.
Contact Applus Technologies, Inc. to schedule training.
C. Certification and Signature of Applicant
(application not complete without signature)
Final approval is dependent upon successful completion of inspector training. For further training information,
contact Applus Technologies at 1-844-358-0135.
Out-of-state applications must send a copy of their valid driver license from issuing state and will be processed through the National
Driver Register (NDR) and/or the Commercial Driver License Information System (CDLIS) to verify the status of operating privileges
in other jurisdictions. I, the undersigned, hereby apply for a license to inspect motor vehicles and swear (affirm), under the penalties
of perjury, that the information I have provided in this application is true and correct.
Signature: ________________________________________________________________ Date: ___________________________
p.1
VSC104_0218