STATE OF WYOMING
                 AFFIDAVIT OF VEHICLE EVALUATION

STATE OF WYOMING       )
                                                   SS
COUNTY OF WASHAKIE  )

  The undersigned, being first duly sworn on oath according to law deposes and says upon information a belief:  the undersigned is the owner of the following described vehicle:

  MANUFACTURER’S RETAIL PRICE, new (incl. Optional equipment) $____________

                                                                                        _____________________________
                                                                                                         Signature
_______________________________________________________________________
AFFIDAVIT OF INSPECTION & CERTIFICATION OF CORRECT “VIN” NUMBERS

  W.S. 31-3-102 (b) provides a five-dollar ($5.00) fee shall be collected for each vehicle identification number inspected pursuant to W.S. 31-2-103 (a) (vi)
The undersigned being first fully sworn on solemn oath according to law, and subject to penalties of perjury, deposes and says:
The inspection occurred in Wyoming and was made by:

             City Police _________  County Sheriff _________            Highway Patrol__________
MAKE _____________________ MODEL___________________________YEAR__________
COLOR ____________________ ODOMETER_______________________________________
VIN # ____________________________________________

At the request of applicant for a Wyoming Certificate of Title, I personally inspected the vehicle identification number on the described vehicle and the information entered by me is correct.

                                                  Representing (agency)             ______________________________

                                                                    (address)            ______________________________

                                                (Officer’s Signature )               ______________________________

                                                                       (date)               ______________________________

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