State of New Hampshire
Department of Safety
Division of Motor Vehicles
Bureau of Title and Anti-Theft
Concord, N.H. 03305 (603) 227-4150
VERIFICATION OF VEHICLE IDENTIFICATION
This is to certify that I have physically examined at , N.H., the vehicle described herein:
Location
Year Make Model Body Style GVW Owner’s Reg. No.
and found the vehicle identification number to be
The vehicle identification number appears to be Altered Unaltered Changed Missing
Owner of Vehicle Address
I further certify that the above referred to Vehicle Identification Number was not obtained from any registration or documents relative to this vehicle and
was obtained by a visual inspection of the Public V.I.N. Plate. Any alterations to the information contained in this form shall make it invalid.
By Date
Agent’s Signature Agent’s Printed Name
This application is signed under penalty of unsworn falsification pursuant to RSA 641:3.
This form shall only be completed in its entirety by the authorized agents listed below:
New Hampshire Law Enforcement Officer Badge # Agency
Authorized N.H. Licensed Auto Dealer Plate # Address
Authorized N.H. Inspection Station # Tel. No.
Authorized Agent of the Director TDMV 19A (Rev. 01/17)
Elizabeth A. Bielecki
Director of Motor Vehicles
John J. Barthelmes
Commissioner of Safety
State of New Hampshire
Department of Safety
Division of Motor Vehicles
Bureau of Title and Anti-Theft
Concord, N.H. 03305 (603) 227-4150
VERIFICATION OF VEHICLE IDENTIFICATION
This is to certify that I have physically examined at , N.H., the vehicle described herein:
Location
Year Make Model Body Style GVW Owner’s Reg. No.
and found the vehicle identification number to be
The vehicle identification number appears to be Altered Unaltered Changed Missing
Owner of Vehicle Address
I further certify that the above referred to Vehicle Identification Number was not obtained from any registration or documents relative to this vehicle and
was obtained by a visual inspection of the Public V.I.N. Plate. Any alterations to the information contained in this form shall make it invalid.
By Date
Agent’s Signature Agent’s Printed Name
This application is signed under penalty of unsworn falsification pursuant to RSA 641:3.
This form shall only be completed in its entirety by the authorized agents listed below:
New Hampshire Law Enforcement Officer Badge # Agency
Authorized N.H. Licensed Auto Dealer Plate # Address
Authorized N.H. Inspection Station # Tel. No.
Authorized Agent of the Director TDMV 19A (Rev. 01/17)
Elizabeth A. Bielecki
Director of Motor Vehicles
John J. Barthelmes
Commissioner of Safety
State of New Hampshire
Department of Safety
Division of Motor Vehicles
Bureau of Title and Anti-Theft
Concord, N.H. 03305 (603) 227-4150
VERIFICATION OF VEHICLE IDENTIFICATION
This is to certify that I have physically examined at , N.H., the vehicle described herein:
Location
Year Make Model Body Style GVW Owner’s Reg. No.
and found the vehicle identification number to be
The vehicle identification number appears to be Altered Unaltered Changed Missing
Owner of Vehicle Address
I further certify that the above referred to Vehicle Identification Number was not obtained from any registration or documents relative to this vehicle and
was obtained by a visual inspection of the Public V.I.N. Plate. Any alterations to the information contained in this form shall make it invalid.
By Date
Agent’s Signature Agent’s Printed Name
This application is signed under penalty of unsworn falsification pursuant to RSA 641:3.
This form shall only be completed in its entirety by the authorized agents listed below:
New Hampshire Law Enforcement Officer Badge # Agency
Authorized N.H. Licensed Auto Dealer Plate # Address
Authorized N.H. Inspection Station # Tel. No.
Authorized Agent of the Director TDMV 19A (Rev. 01/17)
Elizabeth A. Bielecki
Director of Motor Vehicles
John J. Barthelmes
Commissioner of Safety
State of New Hampshire
Department of Safety
Division of Motor Vehicles
Bureau of Title and Anti-Theft
Concord, N.H. 03305 (603) 227-4150
VERIFICATION OF VEHICLE IDENTIFICATION
This is to certify that I have physically examined at , N.H., the vehicle described herein:
Location
Year Make Model Body Style GVW Owner’s Reg. No.
and found the vehicle identification number to be
The vehicle identification number appears to be Altered Unaltered Changed Missing
Owner of Vehicle Address
I further certify that the above referred to Vehicle Identification Number was not obtained from any registration or documents relative to this vehicle and
was obtained by a visual inspection of the Public V.I.N. Plate. Any alterations to the information contained in this form shall make it invalid.
By Date
Agent’s Signature Agent’s Printed Name
This application is signed under penalty of unsworn falsification pursuant to RSA 641:3.
This form shall only be completed in its entirety by the authorized agents listed below:
New Hampshire Law Enforcement Officer Badge # Agency
Authorized N.H. Licensed Auto Dealer Plate # Address
Authorized N.H. Inspection Station # Tel. No.
Authorized Agent of the Director TDMV 19A (Rev. 01/17)
Elizabeth A. Bielecki
Director of Motor Vehicles
John J. Barthelmes
Commissioner of Safety
