Motor Vehicle Appraisal for Tax Collector
Hearing / Bonded Title
Information
This form may only be used to establish the value of a motor vehicle if the department is unable to establish the value
by using the Standard Presumptive Value or from a national reference guide. Use of this form is strictly limited to
establishing the value of a motor vehicle for use in a bonded title or tax assessor-collector hearing.
The appraiser must inspect the motor vehicle in person and provide all information requested in the “Appraiser
Information” and “Appraisal Information” sections.
Vehicle Information
Vehicle Identification Number
Year
Make
Body Style
Model
First Name (or Entity Name)
Last Name
Suffix (if any)
Additional Applicant First Name (if applicable)
Last Name
Suffix (if any)
Address
State
Zip
Email (optional)
Phone Number (optional)
Applicant Information
Appraiser Information
Appraiser Type:
Motor Vehicle Dealer
Insurance Adjuster
Motor Vehicle Dealer or Insurance License Number
Licensed Motor Vehicle Dealer or Insurance Company Name
Appraiser’s First Name
Last Name
Suffix (if any)
Address
State
Zip
Email
Phone Number
Date of Appraisal
Appraisal Information
Vehicle Condition:
Complete Vehicle Incomplete Vehicle
Appraised Value
$
Comments
Appraiser Certification State law makes falsifying information a third degree felony
I, the above listed appraiser, certify I have personally inspected the above described vehicle, have provided a fair market appraised
value for the vehicle, and all statements contained herein are true and correct to the best of my knowledge.
Signature of Apprasier
Printed Name (Same as Signature)
Date
VTR-125 Rev 08/16 Form available online at www.TxDMV.gov Page 1 of 1