"Affidavit of Final Assembler of Motor Vehicle Glider Kit" - Nebraska

Affidavit of Final Assembler of Motor Vehicle Glider Kit is a legal document that was released by the Nebraska Department of Motor Vehicles - a government authority operating within Nebraska.

Form Details:

  • Released on September 1, 2018;
  • The latest edition currently provided by the Nebraska Department of Motor Vehicles;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • 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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Download "Affidavit of Final Assembler of Motor Vehicle Glider Kit" - Nebraska

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Affidavit of Final Assembler
of Motor Vehicle
Glider Kit
Application for certificate of title for the following described glider kit motor vehicle is being made:
__________
________________
______________
______________________________
(Year)
(Make)
(Model)
(VIN)
The undersigned, being duly sworn, depose or affirm that the following is true about the above described glider
kit:
 Applicant is the final assembler of the glider kit. If final assembly was performed by a dealer, provide name and
number of dealership: Dealer Name:
____________________ Dlr. Number: _________
 The major component parts used in the assembly were removed from the following titled motor
vehicle(s) and installed in the above described glider kit. If the motor vehicle(s) from which the
component parts were removed are being junked at this time, the title(s) is enclosed. If junked at a later
date; I understand the law requires the surrender of the title(s) any County Treasurer, or to the Nebraska
Department of Motor Vehicles
________
_________
_________
_______________________
_________________
(Year)
(Make)
(Model)
(VIN)
(Title Number)
OR
 The major component parts used in the assembly of this glider kit were purchased and were not obtained through
fraudulent or illegal means. (complete section below)
COMPONET PARTS: (If completed, submit the Bill of Sale for the engine and transmission)
Engine
Make
Model
Serial Number
Transmission
Make
Model
Serial Number
Rear Axle:
Make
Model
Serial Number
Suspension
Make
Model
Serial Number
Fifth Wheel
Make
Model
DATED this _______________day of ______________________, ______________.
______________________________________
(Applicant)
Subscribed and sworn to before me this _____________day of _____________, ___________.
_______________________________________
(Notary Public or Designated County Official)
Note: This affidavit is required to be submitted with an Application for Certificate of Title for a Glider Kit along with proper
proof of ownership.
Revised 9/2018
Affidavit of Final Assembler
of Motor Vehicle
Glider Kit
Application for certificate of title for the following described glider kit motor vehicle is being made:
__________
________________
______________
______________________________
(Year)
(Make)
(Model)
(VIN)
The undersigned, being duly sworn, depose or affirm that the following is true about the above described glider
kit:
 Applicant is the final assembler of the glider kit. If final assembly was performed by a dealer, provide name and
number of dealership: Dealer Name:
____________________ Dlr. Number: _________
 The major component parts used in the assembly were removed from the following titled motor
vehicle(s) and installed in the above described glider kit. If the motor vehicle(s) from which the
component parts were removed are being junked at this time, the title(s) is enclosed. If junked at a later
date; I understand the law requires the surrender of the title(s) any County Treasurer, or to the Nebraska
Department of Motor Vehicles
________
_________
_________
_______________________
_________________
(Year)
(Make)
(Model)
(VIN)
(Title Number)
OR
 The major component parts used in the assembly of this glider kit were purchased and were not obtained through
fraudulent or illegal means. (complete section below)
COMPONET PARTS: (If completed, submit the Bill of Sale for the engine and transmission)
Engine
Make
Model
Serial Number
Transmission
Make
Model
Serial Number
Rear Axle:
Make
Model
Serial Number
Suspension
Make
Model
Serial Number
Fifth Wheel
Make
Model
DATED this _______________day of ______________________, ______________.
______________________________________
(Applicant)
Subscribed and sworn to before me this _____________day of _____________, ___________.
_______________________________________
(Notary Public or Designated County Official)
Note: This affidavit is required to be submitted with an Application for Certificate of Title for a Glider Kit along with proper
proof of ownership.
Revised 9/2018