T-22B (Rev. JULY 2013)
All Previous Revisions are Obsolete
State of Georgia
Department of Revenue
Motor Vehicle Division
Certification of Inspection by a Duly Constituted Georgia Law Enforcement Officer
All Previous Revisions are Obsolete
Any strike-over or corrections void this form. This form must be printed and legible and is valid only when
completed-in-full and signed by a Georgia Law Enforcement Officer.
VEHICLE DESCRIPTION
INSPECTION OF PUBLIC (PVIN) AND MOTOR VEHICLE SAFETY LABEL (FEDERAL STICKER)
PUBLIC VEHICLE IDENTIFICATION NUMBER ATTACHED (CIRCLE APPROPRIATE RESPONSE)
Has the manufacturer affixed a National Highway Transportation Safety Administration (NHTSA) Label certifying the vehicle,
motorcycle or scooter conforms to applicable U.S. Federal Motor Vehicle Safety Standards (FMVSS)? YES NO
SUPPORTING DOCUMENTATION ESTABLISHING OWNERSHIP OF THE APPLICANT
CERTIFICATE OF TITLE/STATE
OF ISSUANCE
TAG INFO – (LAST KNOWN
REGISTRATION AND STATE)
MANUFACTURER
STATEMENT OF ORIGIN
IF NO TITLE OR TAG, DESCRIBE
DOCUMENTS PRESENTED
PERSON IN POSSESSION OF VEHICLE
RESIDENTIAL or BUSINESS ADDRESS
CERTIFICATION OF GEORGIA LAW ENFORCEMENT OFFICER
AGENCY NAME & PHONE NUMBER
GCIC/NCIC RESPONSE TO STOLEN INQUIRY (GCIC/NCIC DATE/TIMESTAMP)
The signature of the duly constituted law enforcement officer examining this vehicle certifies pursuant to
DOR Rule 375-2-12-.08, that said officer completed this form and conducted an inquiry on the Georgia
Crime Information Center’s (GCIC) and/or National Crime Information Center’s (NCIC) stolen vehicle files
to establish the status of this vehicle under the penalty of false swearing (O.C.G.A. §16-10-71).
____________________________________________________ ____________________________
SIGNATURE DATE
REMARKS:
VISABLE THROUGH WINDSHEILD?
