WYOMING DEPARTMENT OF TRANSPORTATION
PO BOX 1708
CHEYENNE, WY  82003-1708

  OUT OF STATE VEHICLE IDENTIFICATION NUMBER INSPECTION
 APPLICATION TO COUNTY CLERK FOR MOTOR VEHICLE CERTIFICATE OF TITLE
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APPLICANT INFORMATION
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Name of Owner_________________________________________________________________________
Address_______________________________________________________________________________
Seller’s Name/Address___________________________________________________________________
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VEHICLE INFORMATION
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Make ____________Year____________  Body Style_____________New _________  Used____________ Odometer__________________ Purchase Date_______________________ TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT
AFFIDAVIT OF INSPECTION AND CERTIFICATION OF “VIN” NUMBER TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT
I have physically inspected the above described vehicle to verify the Identification Number.

  THE VEHICLE IDENTIFICATION NUMBER IS:

The inspection occurred in _____________________________________________ and was made by:                                                                      (City/State)
 _____City Police Dept. _____County Sheriff’s Office _____Highway Patrol _____Commissioned Military Officer
 At the request of the applicant, I personally inspected the vehicle Identification Number on the described vehicle and the information entered by me is correct.
Officer’s Name _____________________________________ Badge # ___________________________
                                      (Please print or type)
 Agency and Location ___________________________________________________________________
Telephone # _______________________________________
Signature _________________________________________  Date _______________________________

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NOTARY STATEMENT
TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT  SUBSCRIBED AND SWORN TO BEFORE ME THIS ________ DAY OF _______________, ________

                                                                                      ___________________________________
                                                                                                SIGNATURE OF NOTARY
MV-300B (4-95)
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