VP198 (8/2012) Signatures must be originals. Photocopies are not acceptable.
Changes may not be made to this form once it is signed and witnessed.
555 WRIGHT WAY
CARSON CITY, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
dmvnv.com
AFFIDAVIT OF NON-RESIDENCY
Please Print or Type
I hereby certify on _______________________________________, I purchased a
Month Day Year
Year Make Model Vehicle Identification Number (VIN)
from ________________________________ a Nevada dealer. I purchased the vehicle
Name of Nevada Dealer
as a non-resident living at ________________________________________________
Street City County Zip Code
At the time of purchase, I was furnished the Certificate of Title, a notarized Bill of Sale,
and a Special Drive-Away Permit.
I subsequently have moved to Nevada, my addresses are:
Physical Address _______________________________________________________
Street City County Zip Code
Mailing Address _______________________________________________________
Street /PO Box City County Zip Code
I hereby make application for a Nevada Certificate of Registration and/or Certificate of
Title. I also certify the above information is not in violation of Nevada Revised Statute
482.436 which states:
Any person is guilty of a gross misdemeanor who knowingly:
1. Makes any false entry on any Certificate of Origin or Certificate of Title;
2. Furnishes false information to the Department concerning any security interest; or
3. Fails to submit the original of the dealer or rebuilder’s report of sale of a used or
rebuilt vehicle to the Department within the time prescribed in subsection 3 of NRS
482.424.
NRS 482.465 states the Department shall rescind and cancel a Certificate of Title or
Certificate of Registration and license plates which have been issued erroneously or
improperly or obtained illegally.
Applicants Printed Name _________________________________________________
Nevada Driver’s License, Identification
Number, or Date of Birth ___________________
Signed and sworn to before me on ________________
Date
By __________________________________ Notary Stamp
Signature of Affiant
______________________________________________
Notary Public or Authorized Nevada DMV Representative
