ADDITIONAL VEHICLE INFORMATION QUESTIONS 1-4 MUST BE COMPLETED.
CERTIFICATION: I certify that the information I have given on this application and on any documentation provided in support of this
application is true and complete. I certify that the vehicle is fully equipped as required by the Vehicle and Traffic Law, and has passed the
required New York State inspection, or has qualified for a time extension (form VS-1077) and will be inspected within 10 days. I also
certify that appropriate insurance coverage is in effect, and that the vehicle will be operated in accordance with the Vehicle and Traffic
Law. If I am applying for replacement registration items, I certify that the registration is not currently under suspension or revocation. If I
have plates in a series reserved for a special group, I certify that I am still eligible to receive them, and that I have only one set of these
If I am using a credit card for payment of any fees in connection with this application, I understand that my signature below also
authorizes use of my credit card.
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(Print Name in Full - if registering for a corporation, print your full name and title)
Additional Signature Sign Here ç
Print Name Here ç
(Print Name in Full)
(Sign Here - Additional signature required for a partnership or if registering this vehicle in more than one name.)
Print Additional Name Here ç
Sign Here ç
WARNING: Intentionally making a false statement or providing false or misleading information in connection with this application is a criminal
offense that may subject you to prosecution under the law.
5. This vehicle is a pick-up truck with an unladen weight that is a maximum of 6,000 pounds. This vehicle is never used for commercial
purposes and does not have advertising on any part of it. I want (mark one):
3. Has this vehicle been modified from the original manufacturer specifications?
o Yes o No If “Yes”, describe the modifications:
2. Is this vehicle registered for your personal use? o Yes o No
If you marked “Yes”, go to the next question (question 3). If you marked “No”, check any of these boxes that apply:
o This vehicle is a passenger vehicle that will be used for hire with a driver and will be operated in the following location(s):
o New York City (NYC) o A jurisdiction that is not NYC that regulates taxis o A jurisdiction that does not regulate taxis
o This vehicle is used as a contracted carrier.
o This vehicle is a passenger vehicle that is rented without a driver.
o This vehicle requires a permit for commercial operation. (Mark the box of the type of permit that was issued and write the permit
number on the line.)
o NYS DOT Permit No. ___________________ o Federal DOT Permit No. ____________________
o The government owns this vehicle.
o This vehicle is used as (mark one) o an ambulance o an ambulette o a hearse or invalid coach
If payment is received to carry passengers, mark this box.o
o This vehicle is used exclusively as a hearse. If payment is received to carry passengers, mark this box.o
o This vehicle is a commercial tow truck with a gross vehicle weight rating of at least 8,600 pounds.
o This vehicle is used only as a farm vehicle. (form MV-260F, Part 1, must be attached)
o This vehicle is used only as an agricultural truck or agricultural trailer.
o This vehicle is subject to the Department of Transportation inspection requirements for the carriers that transport passengers.
(For more information, refer to form MV-82.1P, “Inspection Requirements for Carriers Transporting Passengers”.)
o Passenger Plates o Commercial Plates
1. Has the vehicle been wrecked, destroyed, or damaged to such an extent that the total estimate, or actual cost, of parts and labor to
rebuild or reconstruct the vehicle to the condition it was in before an accident, and to make the vehicle legal to operate on the road or
highways, is more than 75% of the retail value of the vehicle at the time of loss?
o No o Yes - (If you marked Yes the vehicle must have an anti-theft examination before it is registered. The title that is issued
will have the statement “Rebuilt Salvage” on it.)
4. Was this vehicle altered to increase the capacity beyond that provided by the manufacturer by method of extended chassis, lengthened
wheel base, or a lengthened seating area?
* If your vehicle was altered or stretched to increase the passenger capacity, you must present to the DMV issuing office a photograph or copy
of all labels or plates (normally put on the driver’s side door). If the vehicle was altered or stretched and now has an adult seating capacity of
9 or more adults (including the driver), you must show the original NYS DOT Inspection Receipt OR a NYS DOT Exemption Letter.
, and the vehicle was altered on or after 1/1/2021, is this altered vehicle equipped with safety belts at all occupant seating
Yes No N/A, vehicle altered prior to 1/1/2021
ES, do you have the required Federal Alterer’s Safety Certification (normally found on the door jamb) in accordance with