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This is to certify that I have physically (Town of Hampton, NH)

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Robert L. Quinn
Commissioner of Safety
State of New Hampshire
Department of Safety - Division of Motor Vehicles
Bureau of Title and Anti-Theft
23 Hazen Drive, Concord, NH 03305
Telephone: (603)227-4000 TDD Access Relay NH 7-1-1
Elizabeth A. Bielecki
Director of Motor Vehicles
VERIFICATION OF VEHICLE IDENTIFICATION
TDMV 19A (Rev. 1/20)
This is to certify that I have physically examined at
, N.H., the vehicle described herein:
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
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.
Date
By
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 one of the authorized agents listed below:
Agency
Address
Tel. No.
New Hampshire Law Enforcement Officer Badge #
Authorized NH Licensed Auto Dealer Plate #
Authorized NH Inspection Station Station #
Authorized Agent of the Director
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This is to certify that I have physically (Town of Hampton, NH)

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Completed 3 August 2020

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