Fillable 559 Out Of State VIN Inspection Form (Natrona County)

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559 Out Of State VIN Inspection Form (Natrona County)

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STATE OF WYOMING
Application for Certificate of Title and VIN/HIN Inspection Form
Motor Vehicle
Trailer
Snowmobile
Watercraft
Mobile Home
Date Title Issued:
** For Watercraft, please place the corresponding number from the guide below into the respective watercraft information box
.
MANUFACTURER
YEAR
VEHICLE /
HULL IDENTIFICATION NO.
BODY STYLE /
VESSEL TYPE
PROPULSION
ENGINE
DRIVE
FACTORY PRICE /
MSRP
STATE
PRIOR TITLE NO.
HULL
MATERIAL
ODOMETER /
VESSEL LENGTH
PURCHASE DATE
WEIGHT
> >
BRANDED TITLE / SALVAGE DISCLOSURE
<
<
EVERY
APPLICANT FOR A MOTOR VEHICLE TITLE IS REQUIRED TO COMPLETE THIS
SECTION.
Please circle and initial the appropriate response to these two questions. The salvage definition and requirements are on the reverse side of this
page.
A.)
Does this motor vehicle currently have or ever had a branded title?
Yes
No
(Initials: )
B.)
Has this motor vehicle been declared a total loss by an insurance company
OR
sustained 75% damage of actual cash value?
Yes
No
OWNER / SELLER INFORMATION
(Please print clearly)
NAME OF OWNER
JTWROS
ADDRESS CITY STATE ZIP
NAME OF SELLER
ADDRESS
CITY
STATE ZIP
LIEN INFORMATION
(Please print clearly)
NAME OF LIEN HOLDER
ADDRESS
CITY
LIEN FILING #
AMOUNT
FILE DATE
I/WE HEREBY SWEAR OR AFFIRM
under penalty of perjury that all information on this application is true and correct and that I/we am/are lawfully applying for a Wyoming Certificate
of Title. I/we further warrant that said vehicle is owned by me/us and is subject to the liens shown and none other. I/we further certify to the best of my/our knowledge that if the vehicle
is a mobile home, all taxes due on the mobile home for the preceding and current year have been paid and in the event taxes have not been paid, acknowledge that I/we may be
responsible for the taxes for the preceding and current year. Any false information may cancel the title and void any registration associated with the title.
SIGNATURE of
OWNER/APPLICANT(s):
_____________________________________
________________________________________________________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
NOTARY STATEMENT
(Required on all applications)
(SEAL)
STATE OF ______________________
COUNTY OF ____________________
Subscribed and sworn to before me by ______________________________________________________this
day of _______________ 20________
Office of County Clerk or Notary Signature
My Commission Expires:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~“V I N” or
“H I N”
Inspection Form~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
** Before completing the V.I.N. or
H.I.N.
inspection, please review the “NOTICE” on the reverse side or this form to determine if you are authorized by
statute to do so. Please print the vehicle/
watercraft
information as accurate and legible as possible and then verify with your signature at the bottom.
___________________________________________________________________________________________________
NCIC of VIN or
HIN
:
Yes
No
[Vehicle Identification Number
(VIN)
/
Hull ID Number
(HIN)
HIN’s are required to have 12 alpha -numeric digits, with no spaces or dashes
.
]
(
Please
Circle One)
Year:
______________
Make:
______________________________
Model:
______________________________
Trim:
______________________________
(Ford, Jeep, Chevr, Honda, etc.) (F-150, Camaro, Mustang, Wrangler, etc.) (XLT, Lariat, GT, LS, Rubicon, etc
.)
Subject to the penalties of perjury,
I,
__________________________________________________________
BADGE/TITLE/DLR NUMBER,
__________________________ am
(Whichever Applicable)
an authorized member or employee of,
AGENCY
or
ENTITY NAME ,_____________________________________________________________________________
Please Circle One
: Police Dept. Sheriff’s Office Highway Patrol State Police G&F Other Entity
depose and state that, I personally inspected the VIN or
HIN
in the
state of,______________________________________________
on the above described
vehicle/
watercraft
and the information entered by me is true and correct. The undersigned verifies that I am authorized by the laws of Wyoming
(or state where the
inspection occurred), to conduct this inspection.
Date:______________
SIGNATURE:
____________________________________________________________________ Phone:_____________________
W.S. 31-3-102(b) provides a $ 10.00 fee be collected for each vehicle/hull identification number inspected pursuant to W.S. 31-2-103(a)(vi)
MV-300A (6/13)
Hull Material
1-Fiberglass 2-Aluminum 3- Wood 4-Steel
5-Rubber/Vinyl/Canvas 6- Rigid Hull Inflatable 7 -Other
Propulsion Type
1-Propeller 2-Sail 3- Waterjet
4-Airthrust 5-Manual
Engine Drive
1-Outboard 2-Inboard
3-Inboard/Stern Drive
Vessel Type
1-Canoe / Kayak 2-Open Motorboat 3 - Rowboat 4-Cabin Motorboat 5-Pontoon Boat
6-Houseboat 7-Personal Watercraft (Jet Ski) 8- Sail Boat 9-Other
-
2
STATE
ZIP
NOTICE:
The person conducting the
VIN
(vehicle) or
HIN
(watercraft)
identification number inspection SHALL be authorized by
their state statute regarding inspections of this nature. Any person who conducts a VIN or
HIN
inspection and is not lawfully
authorized to do so shall be cause to void the title application and may void any title or registration issued that is related to this
VIN or
HIN
inspection. In addition,
YOU MAY BE SUBJECT TO CRIMINAL PENALTIES.
(A VALID HIN on a watercraft is
required to have 12 alpha-numeric digits, with no spaces or dashes.
)
Wyoming
V.I.N.
Inspection Statutes
W.S. 31-2-103. Contents of application; signature; vehicle identification number; issuance of
certificate.
(a) (vi) In the case of a vehicle registered or titled in a state other than Wyoming,or any
homemade vehicle, rebuilt vehicle, reconstructed vehicle, any vehicle assembled from a kit or any vehicle
for which a bond is required, a current statement made by a Wyoming law enforcement officer
,
or
licensed
Wyoming dealer only for vehicles in his inventory or possession,
that the vehicle identification number on
the vehicle has been inspected and that the inspection occurred in Wyoming and certifying the correct
vehicle identification number displayed on the vehicle. Any licensed Wyoming dealer performing an
inspection of a vehicle identification number under this section shall, in addition to the requirements of
this act, do so pursuant to W.S. -11-108.
In the case of a vehicle not in Wyoming
,the vehicle
identification number may be inspected and certified on a form approved by the department if the
inspection is made by an authorized law enforcement officer of a city, county or state law enforcement
agency or a commissioned officer at a federal military installation
or any other person authorized to do
so by law
and delivered to the county clerk in the county where the application for certificate of title
is made along with payment for the inspection fee required under W.S. 31-3-102(b)(iv);
(ix) Such other information as required by the department or county clerk which may include but
not be limited to a vehicle bill of sale or similar document, any documentation necessary to verify proof
of ownership including an affidavit for proof of ownership or any surety bond required by this act. Any
affidavit for proof of ownership shall be prescribed pursuant to W.S. 31-1-201(d) and shall be utilized by
each county of this state;
(x) A Wyoming certificate of title shall contain an appropriate notice whenever records readily
accessible to the state indicate that the motor vehicle was previously issued a title or registration from
any jurisdiction that bore any word or symbol signifying that the vehicle was "salvage", "unrebuildable",
"parts only", "scrap", "junk", "nonrepairable", "reconstructed", "rebuilt" or any other symbol or word of
like kind, or that it has been damaged by flood. Any information concerning a motor vehicle's status
shall also be conveyed on any subsequent title issued for the vehicle by this state, including a duplicate
or replacement title.
(d) Upon receipt of an application and payment of fees any county clerk shall, if satisfied that
the applicant is the owner of the vehicle for which application for certificate of title is made,
issue a
paper certificate of title or electronic certificate of title, if available, upon a form or electronic
format, approved by and provided at cost to the county clerk by the department in the name of the owner
bearing the signature and seal of the county clerk's office. The county clerk shall not deliver a
certificate of title issued under this section until presentation of a receipt for payment of sales or use
tax pursuant to W.S. 39-15-107(b) or 39-16-107(b).
Wyoming
Salvage
Statute Information
W.S. 31-2-107. Titles for damaged vehicles; return of certificate of title and registration for
damaged vehicle; replacement title and registration.
(a) When a motor vehicle is declared a total loss by the insurance company
or
, in the event an
insurance company is not involved in the settlement of the claim, sustains damage in an amount exceeding
seventy-five percent(75%) of its actual retail cash value, as set forth in any current edition of a
nationally recognized automotive appraisal guide or other source approved by the Wyoming insurance
department, the owner or insurance company, if it obtains ownership of the vehicle through transfer of
title as a result of a settlement of an insurance claim, shall forward the properly endorsed certificate
of title to the office of the county clerk that issued the certificate of title together with an
application for a certificate of title branded salvage and payment of the fee required under W.S.
31-3-102(a)(vii) to obtain a properly branded certificate of title.
When any vehicle accident report is
required under chapter 5, article 11 of this title, the investigating officer shall provide written notice
to the owner or operator of the vehicle of the requirements under this section.
(d) This section shall not apply to motor vehicles with more than eight (8) years of service
except
any vehicle that was previously issued a title from any state that bore any word or symbol signifying that
the
vehicle
was
"salvage",
"unrebuildable",
"parts
only",
"scrap",
"junk",
"nonrepairable",
"reconstructed", "rebuilt" or any other symbol or word of like kind, or that it has been damaged by flood,
shall obtain a Wyoming title with the prior brand or any other information concerning the motor vehicle
status
,
carried forward on any subsequent Wyoming title regardless of years of service.
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559 Out Of State VIN Inspection Form (Natrona County)

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Completed 18 July 2020

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