Verification Of Vehicle Identification Number
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Verification Of Vehicle Identification Number Form. This is a Virginia form and can be use in Department Of Motor Vehicles Statewide.
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Tags: Verification Of Vehicle Identification Number, VSA 69, Virginia Statewide, Department Of Motor Vehicles
VSA 69 (04/18/05)
VERIFICATION OF
VEHICLE IDENTIFICATION NUMBER
Purpose:
A DMV representative uses this form when inspecting a vehicle to verify that the vehicle identification
number (VIN) entered on the form matches the VIN plate attached to the vehicle.
Upon completion of the vehicle examination, finalize this form and return it to DMV at the above address.
Instructions:
The information provided in no way attests to the authenticity of the plate or the numbers on the plate.
VEHICLE INFORMATION
VEHICLE MAKE
YEAR MODEL
BODY TYPE
TITLE NUMBER
STATE
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE IDENTIFICATION NUMBER (VIN)
MISSING
NCIC HIT
APPEARS TO BE:
CHANGED
YES If yes, list DOT
NO
ALTERED
OCA
TAMPERED WITH
and ORI
VEHICLE OWNER
OWNER FULL LEGAL NAME (LAST)
(FIRST)
ADDRESS
CITY
(MIDDLE)
STATE
ZIP CODE
CERTIFICATION
I certify that I have physically examined the VIN plate attached to the vehicle described above and verify that the above information is
true and valid.
DMV REPRESENTATIVE NAME (print)
POSITION NUMBER
SIGNATURE
DATE
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