Form VP-64A "Certificate of Inspection for Rebuilt Vehicles (Not Salvage)" - Nevada

What Is Form VP-64A?

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 June 1, 2011;
  • 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 VP-64A 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 VP-64A "Certificate of Inspection for Rebuilt Vehicles (Not Salvage)" - 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 FOR REBUILT VEHICLES (NOT SALVAGE)
NRS 482.098, NRS 482.220 & NRS 482.223
.
OWNERSHIP DOCUMENTS MUST ACCOMPANY THIS FORM FOR THE DEPARTMENT TO TITLE OR REGISTER
Instructions
All parts of this form must be completed.
Part I must be completed by a Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder.
Part II must be completed by the vehicle owner and verify with a Nevada DMV Agency Representative or Notary Public.
Part III must be completed by a Nevada DMV Agency Representative.
Important: Corrections on this form will not be accepted. – If a mistake is made, you must complete a new form.
PART I
Safety Inspection
Must be completed by a Nevada Registered Garage, Licensed Nevada Body
Shop,
or Rebuilder
Year____________________ Make__________________________ Model__________________________ Type___________________
Vehicle Identification Number (VIN)
Check () the Appropriate Box(es) to indicate components replaced.
 Cowl
 Rear clip
 Roof assembly
 Floor pan assembly
 Complete front inner structure of a unibody
 Conventional frame & one major component
NOTE: In addition to all other disclosures, by signing Part I below the affiant attests that the item(s) checked have been installed to the
applicable standards of the manufacturer and the automotive repair industry and are in a safe operating condition.
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 vehicle is mechanically safe to operate. I further certify the items indicated have been
satisfactorily repaired to the applicable standards of the manufacturer and the motor vehicle repair industry. In addition, I certify any
safety equipment including occupant restraint devices, which were present in the vehicle at the time the vehicle was manufactured are
present and operational to the standards of the manufacturer.
__________________________________________
___________________________________________ __________
Printed Full Legal Name of Affiant
Signature and Position
Date
PART II
AFFIDAVIT OF CONSTRUCTION FOR A REBUILT MOTOR VEHICLE
The undersigned, being duly sworn upon oath, deposes and says they are the owner of the vehicle described on this document. This
vehicle was rebuilt from parts and materials on hand, or parts and materials purchased from a supplier, 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 rebuilt from parts/material on hand
 Vehicle was rebuilt from purchased parts/material, receipts attached
_________ ______________________________________ ___________________ ____________________ ________
Year
Make
Model
Type
No. of axles
Please Print or Type
Affiant’s Full Legal Name _________________________________________________________________________________________
(As appears on Drivers License)
First
Middle
Last
NV Driver’s License, ID Number, or DOB ___________________________________________ Telephone Number (____)____________
Affiant’s Physical Address
________________________________________________________________________________________________
City
State
Zip Code
Affiant’s Mailing Address
_________________________________________________________________________________________________
City
State
Zip Code
Affiant’s Signature _______________________________________________________________________ Date___________________
______________________________________ ____________________________________ ___________
_________
Printed name of Nevada DMV Agency Representative
Signature of Nevada DMV Agency Representative
ID No.
Date
Or Notary Public
Or Notary Public
VP-64A (6-2011)
-
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 FOR REBUILT VEHICLES (NOT SALVAGE)
NRS 482.098, NRS 482.220 & NRS 482.223
.
OWNERSHIP DOCUMENTS MUST ACCOMPANY THIS FORM FOR THE DEPARTMENT TO TITLE OR REGISTER
Instructions
All parts of this form must be completed.
Part I must be completed by a Nevada Registered Garage, Licensed Nevada Body Shop or Rebuilder.
Part II must be completed by the vehicle owner and verify with a Nevada DMV Agency Representative or Notary Public.
Part III must be completed by a Nevada DMV Agency Representative.
Important: Corrections on this form will not be accepted. – If a mistake is made, you must complete a new form.
PART I
Safety Inspection
Must be completed by a Nevada Registered Garage, Licensed Nevada Body
Shop,
or Rebuilder
Year____________________ Make__________________________ Model__________________________ Type___________________
Vehicle Identification Number (VIN)
Check () the Appropriate Box(es) to indicate components replaced.
 Cowl
 Rear clip
 Roof assembly
 Floor pan assembly
 Complete front inner structure of a unibody
 Conventional frame & one major component
NOTE: In addition to all other disclosures, by signing Part I below the affiant attests that the item(s) checked have been installed to the
applicable standards of the manufacturer and the automotive repair industry and are in a safe operating condition.
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 vehicle is mechanically safe to operate. I further certify the items indicated have been
satisfactorily repaired to the applicable standards of the manufacturer and the motor vehicle repair industry. In addition, I certify any
safety equipment including occupant restraint devices, which were present in the vehicle at the time the vehicle was manufactured are
present and operational to the standards of the manufacturer.
__________________________________________
___________________________________________ __________
Printed Full Legal Name of Affiant
Signature and Position
Date
PART II
AFFIDAVIT OF CONSTRUCTION FOR A REBUILT MOTOR VEHICLE
The undersigned, being duly sworn upon oath, deposes and says they are the owner of the vehicle described on this document. This
vehicle was rebuilt from parts and materials on hand, or parts and materials purchased from a supplier, 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 rebuilt from parts/material on hand
 Vehicle was rebuilt from purchased parts/material, receipts attached
_________ ______________________________________ ___________________ ____________________ ________
Year
Make
Model
Type
No. of axles
Please Print or Type
Affiant’s Full Legal Name _________________________________________________________________________________________
(As appears on Drivers License)
First
Middle
Last
NV Driver’s License, ID Number, or DOB ___________________________________________ Telephone Number (____)____________
Affiant’s Physical Address
________________________________________________________________________________________________
City
State
Zip Code
Affiant’s Mailing Address
_________________________________________________________________________________________________
City
State
Zip Code
Affiant’s Signature _______________________________________________________________________ Date___________________
______________________________________ ____________________________________ ___________
_________
Printed name of Nevada DMV Agency Representative
Signature of Nevada DMV Agency Representative
ID No.
Date
Or Notary Public
Or Notary Public
VP-64A (6-2011)
PART III
Completed by a Nevada DMV Agency Representative
Note: Attach copies of any title or purchase documents 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
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.
Additional comments: ________________________________________________________________________________
_____________________________________ _____________________________________ ________ _____________
Printed name of Nevada DMV Agency Representative
Signature of Nevada DMV Agency Representative
ID NO.
Date
“Rebuilt vehicle” (NRS 482.098) means:
1. A vehicle for which one or more of the following major components have been replaced:
(a) Cowl assembly;
(b) Rear clip assembly;
(c) Roof assembly;
(d) Floor pan assembly;
(e) Conventional frame coupled with one additional major component; or
(f) Complete front inner structure for a unibody.
Note: The term “rebuilt” does not include a vehicle for which the only change is the installation of a truck cab assembly.
Definitions
“Complete front inner structure for a unibody” (NRS 482.0154) means the weld on structure of a vehicle, including,
without limitation, the radiator support. Left and right aprons, upper and lower rails and strut towers, designed and
intended to be located forward of the cowl assembly.
“Conventional frame” (NRS 482.0157) means the main longitudinal structural members of the chassis of a vehicle
used as the major support in the construction of the vehicle.
“Cowl assembly” (NRS 482.018) to mean the forward structural portion of a vehicle to which are intended to be
attached all or a part of the windshield frame, fire wall, housing of the instrument panel and hinges for the front
doors.
“Floor pan assembly” (NRS 482.0385) means the pans designed and intended to form the floor of the passenger
compartment of a vehicle.
“Rear clip assembly” (NRS 482.0965) means the entire rear structural portion of a vehicle designed and intended
to be located behind the rear seat of the vehicle.
“Roof assembly” (NRS 482.106) means the structural parts of a vehicle, including, without limitation, more than
one-half of the vertical roof supports, the framework of the roof and the exterior metal skin that together are
designed and intended to be located over the passenger compartment to form the roof of the vehicle.
VP-64A (6-2011)
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