Fillable APPLICATION FOR ASSIGNMENT OF SPECIAL VEHICLE IDENTIFICATION NUMBER (Natrona County)

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APPLICATION FOR ASSIGNMENT OF SPECIAL VEHICLE IDENTIFICATION NUMBER (Natrona County)

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The APPLICATION FOR ASSIGNMENT OF SPECIAL VEHICLE IDENTIFICATION NUMBER (Natrona County) form is 2 pages long and contains:

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APPLICATION FOR ASSIGNMENT OF SPECIAL
VEHICLE IDENTIFICATION NUMBER (VIN)
STEP #1
APPLICANT INFORMATION
Applicant Name
Daytime Phone Number
Mailing Address
City
State
ZIP
Email Address
STEP #2
*A Wyoming VIN can only be issued to Wyoming residents*
Check one:
Homemade Trailer or Trailer with missing VIN
MAKE = “Homemade” or “Factory Make Name” if vehicle is factory made & VIN is missing
YEAR = Year completed if Homemade. If Factory made, provide proof of year; such as pictures from
the internet or manufacturer catalogs. Previous titles and/or registrations are also considered proof of
year.
Other Vehicles
MAKE = “Assembled” if made from 2 or more Factory Makes; or “Factory Make Name” if vehicle is
factory made & VIN is missing
YEAR = Year of oldest major component if Assembled. If Factory made, provide proof of year such as
pictures from the internet or manufacturer catalogs. If vehicle is over 25 years old and applying for a
CUSTOM vehicle license plate put year the vehicle resembles.
STEP # 3
Vehicle Make (Ford,
Homemade, etc..)
Body Style (4-Door Car, Pick-up,
Flatbed Trailer, MC, etc..)
Year (unknown is not
acceptable)
# of Axles
STEP #4
REQUIRED DOCUMENTATION FOR ALL VEHICLES AND TRAILERS:
1. Include a picture of completed vehicle or trailer.
2. FEE: $20.00 (cash, check or money order made payable to WYDOT)
3. Proof of Ownership and completion of statement of facts in Step #5 must accompany this
application.
a. Original Title/MSO/Certificate of Origin and copy of the Bill of Sale from the
vehicle/motorcycle/trailer/etc. that was used in the construction; must accompany this
application. This includes titles from other states. All liens must be released on the title(s),
and the title(s) must be in the name of the applicant, or assigned to the applicant.
b. If there is no Title/MSO/or Certificate of Origin, provide copies of the bill of sale for all
major components used in the construction of the motor vehicle/motorcycle/trailer
i. If you did not build the vehicle, provide proof that the prior owner had authority
to sell the vehicle to you. i.e.: Prior registration data; prior tax data; etc.
c. If there is no Bill of Sale, provide a signed and dated statement in Step #5; explaining
where, when and from whom the major components were purchased.
d. Trailers or vehicles made from all new components must provide proof that all materials
are new; such as receipts from where or whom you purchased the materials.
4. Proof of year of oldest major component; for assembled motor vehicles only.
5. VIN Inspection by law enforcement either in Step #7 or on a VIN inspection form used by law
enforcement; trailers made from a pick-up box are not required to have a VIN inspection.
FOR WYOMING DEPARTMENT OF TRANSPORTATION USE ONLY
Assigned State VIN
By
Date
MV-401 (9/14)
TURN OVER
STEP #5
REQUIRED STATEMENT OF FACTS FOR ISSUANCE OF A WYOMING STATE ASSIGNED VIN-INCLUDE
ATTACHMENT(S) IF ADDITIONAL SPACE IS NEEDED
Why is the VIN number missing or why is there more than one VIN on this vehicle or trailer?
If you constructed the trailer or vehicle, state where, when and from whom the major components were
obtained or purchased.
If the person or business that you purchased or obtained the trailer or vehicle from never had it titled or
registered; explain why.
STEP #6
ANY PERSON CONVICTED OF MAKING A FALSE STATEMENT IN AN APPLICATION IS GUILTY OF A FELONY AND IS
SUBJECT TO A FINE AND/OR IMPRISONMENT. I HEREBY SWEAR OR AFFIRM under penalty of perjury that I am the
owner/builder of the vehicle/trailer described above, and to the best of my knowledge no stolen parts were used
during the construction of this vehicle/trailer and the information provided in this application and supporting
documents is true and correct .
Signature of Applicant
Date
Please verify that you have read and completed Steps #1 through #7
Include original titles and MSO’s if they pertain to your situation
Include copies of the Bill(s)of Sale and/or receipts for new materials
Include a photo of the completed vehicle or trailer
Don’t forget the twenty dollar ($20.00) fee!
APPLICANT SHALL MAIL THIS APPLICATION, REQUIRED DOCUMENTATION AND $20.00 FEE TO:
WYDOT, ATTN: Motor Vehicle Services, 5300 Bishop Blvd., Cheyenne, WY 82009-3340
FOR ADDITIONAL INFORMATION PLEASE CALL: 307-777-4709 or visit our website at http://www.dot.state.wy.us
STEP #7-LAW ENFORCEMENT VIN INSPECTION
AFFIDAVIT OF INSPECTION AND CERTIFICATION OF CORRECT “VIN” OR ABSENCE OF “VIN” TO BE
COMPLETED AND SIGNED BY A LAW ENFORCEMENT OFFICER
Vehicle Make (Factory Make, Homemade,
Assembled, etc)
Year (for homemade trailers, list year trailer
was built)
Vehicle Type (Pickup, passenger
car, boat trailer, etc.)
VIN-If there is no VIN on the vehicle, write “No VIN found”
VIN Location
If there is more than one VIN on the vehicle, list all VIN’s found on the vehicle and where they are located.
(Example: New cab on pickup. List VIN on cab AND VIN on frame so titles surrendered with application can be
matched with vehicles used in construction.)
Additional VIN(S) (if applicable)
VIN Location
At the request of the applicant for special state assigned vehicle identification number, I personally
inspected the vehicle identification number(s) or absence of number on the described vehicle and the
information entered by me is true and correct.
Print Officer’s Name- Name of Law Enforcement Agency
Phone #
( ) -
Signature of Officer- Badge #
Date
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APPLICATION FOR ASSIGNMENT OF SPECIAL VEHICLE IDENTIFICATION NUMBER (Natrona County)

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Completed 18 July 2020

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