Fill - Free fillable DECLARATION OF RECONSTRUCTION/SPECIAL ASSEMBLY (Minnesota Auto & Driver's License of Brainerd) PDF form

MINNESOTA DEPARTMENT OF PUBLIC SAFETY

DRIVER AND VEHICLE SERVICES DIVISION

445 MINNESOTA ST.

ST. PAUL, MN 55101

DECLARATION OF RECONSTRUCTION/SPECIAL ASSEMBLY

It is against Federal and State laws to tamper with or remove a vehicle identification number (VIN) plate or label. Destruction, removal,

alteration, covering or defacement of the original vehicle identification number may be cause for the Department to refuse to title or register your

vehicle. Reconstructed and specially assembled vehicles are subject to a motor vehicle inspection.

Side A - Cars/Trucks/Pickups

This declaration must accompany the application to title your reconstructed or specially assembled vehicle. Original titles, manufacturer's

certificates of origin and/or receipts for all major parts used in the reconstruction must accompany this declaration. Please refer to the Guide for

Reconstructed Vehicles for minimum proof of ownership requirements.

Current License Plate Number:

Current Title Number:

Part Part Number/VIN of Parts Vehicle Obtained From

Body Cab

Frame Chassis

Doors

Fender

Bumper

Quarter Panel

Front End Assembly

Rear Clip

Engine

Transmission

Hood

Roof

Other Changes: Describe fully any other changes such as cutting down the body or frame, changes of springs, wheels, axles, etc.

PS2015A-15 (05/18)

- over -

The person who made the repairs must sign this form.

Important: Minnesota Statute 168A.30 provides that falsifying information on any required document shall be guilty of a felony.

This serves as written confirmation to the Department of Public Safety that the vehicle to be titled meets the requirements of M.S. Chapter

169 for vehicles in its class regarding safety and acceptability to operate on public roads and highways.

Repair Shop Name/Phone

Assembler’s/Rebuilder’s Signature

Owner’s Name

Print Form

Side B- Motorcycles

This declaration must accompany the application to title your reconstructed or specially assembled motorcycle. Original titles,

manufacturer's certificates of origin and/or receipts for all major parts used in the construction must accompany this declaration. Please

refer to the Guide For Reconstructed Vehicles for minimum proof of ownership requirements. If you are doing a reconstruction that

would require the removal of a vehicle identification number (VIN), such as cutting the neck piece for a custom rake, you must contact

the Inspection Unit at (651) 282-2173 before beginning the reconstruction.

Current License Plate Number:

Current Title Number:

Part Part Number/VIN of Parts Vehicle Obtained From

Frame

Engine

Engine Cases

Note: If the engine was not purchased as

a complete assembly, receipts for motor

parts and cases required.

Transmission

Note: If the transmission was not

purchased as a complete assembly,

receipts for transmission parts and cases

are required.

Fork Assembly

Front Wheel Assembly

Rear Wheel Assembly

Other Changes: Describe fully any other changes such as cutting down the body or frame, changes of springs, wheels, axles, etc.

The person who made the repairs must sign this form.

Important: Minnesota Statute 168A.30 provides that falsifying information on any required document shall be guilty of a felony.

This serves as written confirmation to the Department of Public Safety that the vehicle to be titled meets the requirements of M.S. Chapter

169 for vehicles in its class regarding safety and acceptability to operate on public roads and highways.

PS2015A-15 (05/18)

- over -

Repair Shop Name/Phone

Assembler’s/Rebuilder’s Signature

Owner’s Name

DECLARATION OF RECONSTRUCTION/SPECIAL ASSEMBLY

MINNESOTA DEPARTMENT OF PUBLIC SAFETY

DRIVER AND VEHICLE SERVICES DIVISION

445 MINNESOTA ST.

ST. PAUL, MN 55101

GUIDE FOR RECONSTRUCTED AND SPECIALLY ASSEMBLED VEHICLES

Vehicles that have been reconstructed, or specially assembled, are subject to a motor vehicle inspection. Vehicle

identification numbers must be left on all parts. If an identification number appears to have been tampered with or

has been removed, a title may not be issued.

If you are doing a reconstruction that would require the removal of a vehicle identification number (such as cutting the

neck piece on a motorcycle for a custom rake), you must contact the Inspection Unit before beginning the

reconstruction. They will provide you with additional assistance.

Required Application Documents:

• Completed Application to Title and/or Register a Motor Vehicle (PS2000)

• Completed Declaration of Reconstruction (PS2015). Please be specific about the alterations or

reconstruction done to the vehicle.

• Proof of ownership for all major parts used in the reconstruction.

Please note: If minimum proof of ownership for each cab, body or frame of a car or truck; or for the

frame or major components of a motorcycle cannot be provided, the vehicle is subject to bonding. A

statement of facts and an affidavit of protection must accompany the application for title (See back of

this form for minimum ownership requirements).

• If the vehicle was inspected prior to making application, an inspection report marked “passed” and

signed by the inspector who conducted the inspection, must also be submitted.

Additional information or documents may be requested after application is reviewed by central office.

Contacts:

For additional information regarding title applications, forms, registration and fees,

contact Driver and Vehicle Services Division's Public Information Center (651) 297-2126

For information regarding vehicle inspections contact:

Motor Vehicle Inspections Unit at (651) 282-2173

or via email at dvs.motor.vehicles@state.mn.us

PS2015A-15 (05/18)

- over -

Minnesota statute 168A.15 Subd. 3 does not allow DVS to issue titles for junked vehicles. A new title will not be issued to any

vehicle with a title containing the words, "junked, non-repairable, scrapped, dismantled, or destroyed."

Minnesota Statute 235F.6642 requires any branding on a title of an out-of-state vehicle to be included on all future titles used for

that vehicle. For example, if an out-of-state vehicle is branded as flood damaged, that will appear on any future Minnesota title

that is issued for that vehicle.

Minimum Proof of Ownership Requirements

Parts Document Required

• Used Truck Cab

• Used Car Body

• Front Clip, if the clip includes public identification

number

• Used motorcycle frame

A Certificate of Title

• Used Car/Truck Frame

• Used motorcycle engine

A copy of the title (Acceptable only when accompanied by

bills of sales, which identify the vehicle)

• Kit Car

• New Aftermarket motorcycle frame

• New Aftermarket motorcycle motor or motor cases

Manufacturers Certificate of Origin

• Used Car/Truck Frame

• Used Car or Truck Body/Cab, if purchased from a

Minnesota licensed parts dealer. A copy of the dealers

junk report may also be required.

Original Letterhead Receipts

(Receipts must include vehicle identification number of parts

vehicle)

Note: Dealers/Rebuilders cannot submit shop receipts from

their inventory when the application for title is in the name of

the dealer/assembler or rebuilder. They must provide a

source receipt from the party from which the part was

obtained.

• For Car/Truck

Door, Fender, Quarter Panel, Bumper, Engine (call

Inspection Unit for collector vehicles), Transmission,

Rear Clip, Front Clip (If the clip includes public

identification number, a title is required.), other

miscellaneous parts.

• For Motorcycle

Transmission Assembly, Engine Assembly, Front Fork

Assembly and Handle Bars, Front Wheel Assembly,

Rear Wheel Assembly, Seat, Gas Tank, Fenders and

Wiring Harness.

Original Letterhead Receipts

(Vehicle Identification Number not required)

Note: Dealers/Assemblers/Rebuilders cannot submit shop

receipts from their inventory when the application for title is

in the name of the dealer, assembler or rebuilder. They

must provide a source receipt from the party from which the

part was obtained.

• Replacement Cab, or Frame, purchased directly from

manufacturer. In such situations, the invoice is from the

manufacturer to dealer. We would also require a

receipt from the dealer to retail customer.

Original Factory Invoice

Please Note: Additional information or documents may be requested after application is reviewed by central

office. Under M.S. 168A.07, the department may require that the applicant obtain a surety bond to protect

the State against any possible claim of ownership when minimum proof of ownership cannot be provided.

Rev 12/11

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MINNESOTA DEPARTMENT OF PUBLIC SAFETY

GREATER MINNESOTA

Exam Station Contact Site Inspection Day & Time Contact Day & Time Phone

Austin, 430 10th St. NE 2nd & 4th Wed. 8 a.m.-12 p.m. Mon., Tues., Wed. 8 a.m.-4:30 p.m. (507) 434-2675

Bemidji, 111 Second St. Union Square 2nd Tues. 8 a.m.-2:30 p.m. Mon.-Fri. 8 a.m.-4:30 p.m. (218) 308-2940

Detroit Lakes, 1000 Hwy 10 W 2nd & 4th Tues. 8 a.m.-11 a.m.

Mon. & Tues. 8 a.m.-4:30 p.m.

Wed., Thurs., Fri. 8 a.m.-12p.m. & 1-4:30 p.m.

(218) 846-8270

Duluth, 4602 Grand Ave. Ste 990 1st & 3rd Wed. 8:30 a.m.-3:30 p.m. Mon.-Fri. 8 a.m.-4:30 p.m. (218) 216-0834

Faribault, 1105 W. Division St. 2nd Tues. 8 a.m.-12 p.m. Mon.-Thu. 8 a.m.-4:30 p.m. (507) 332-7985

Grand Rapids, 1121 4th Ave. SE 1st & 3rd Tues. 8:30 a.m.-11 a.m. Mon., Tues., Wed. 10 a.m.-12 p.m. (218) 327-4586

*Long Prairie, 17792 US 71 1st & 3rd Mon. 8:30 a.m.- 12 p.m. Mon.-Fri. 8 a.m.-4:30 p.m. (651) 282-2173

Mankato, 2161 Bassett Drive 2nd & 4th Mon. 8:30 a.m.-4 p.m. Mon.-Fri. 8 a.m.-4:30 p.m. (507) 344-2799

Marshall, 601D North Hwy 59 2nd & 4th Tues. 12 p.m.-4 p.m. Tues. 8 a.m.-12 p.m. & 12:30-4:30 p.m. (507) 537-7024

*St. Cloud, 3051 36th Ave. SE,

Tue. 8:30 a.m.-4 p.m.

Wed. 8 a.m.-12 p.m.

Mon.-Fri. 8 a.m.-4:30 p.m. (651) 282-2173

Thief River Falls, 244 125th Ave. NE 4th Mon. 8 a.m.-11 a.m. Mon. 8 a.m.-12 p.m. & 12:30-4:30 p.m. (218) 681-0966

Virginia, MNDOT Bldg., 101 Hoover Rd. 2nd Mon. 12:30 p.m.-4 p.m. Mon.-Fri. 8 a.m.-4:30 p.m. (218) 748-2457

Willmar, 1601 E Hwy 12 Mon. 8 a.m.-11 a.m. Mon.-Fri. 8 a.m.-4:30 p.m. (320) 231-1735

Worthington, 315 10th St. 2nd Wed. 8:30 a.m.-2:30 p.m. Tues. 8 a.m.-12 p.m. & 12:30-4:30 p.m. (507) 376-6551

Minnesota Department of Public Safety 445 Minnesota Street, Suite 186, St. Paul, Minnesota 55101-5186

Driver and Vehicle Services Division (651) 282-2173 (Telephone), (651) 297-2100 (TTY Only)

 Telephone answered only during days and times listed under Contact Day & Time.

*Appointments are scheduled through Driver and Vehicle Services Public Information Center in St. Paul: (651) 282-2173

Rev 04/2018

Schedule of Vehicle Inspections

Revised April 2018

INSPECTIONS ARE DONE BY APPOINTMENT

Inspections may be done without an appointment during the hours listed under Inspection Day & Time, based on the

inspectors' availability.

INSPECTION SITES MAY BE IN DIFFERENT LOCATIONS THAN CONTACT SITES LISTED BELOW.

You must bring all supporting documents with you at the time of the inspection.

METRO AREA

*St. Paul, 222 Starkey Street Monday through Friday, 8:30 a.m.-12 p.m. & 12:30 p.m.-4 p.m. (651) 282-2173

THIS IS NOT A SAFETY INSPECTION

***As of August 1, 2017 the Royalton Inspection site has moved to a new location at 3051 36th Ave. SE, St. Cloud, MN 56304***

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DECLARATION OF RECONSTRUCTIONSPECIAL ASSEMBLY (Minnesota Auto & Driver's License of Brainerd)

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