Proof of Visual Inspection
Proof of Visual Inspection
Registry of Motor Vehicles Title Division P.O. Box 55892 Boston, MA 02205-5892
This vehicle must be submitted for a visual examination of its vehicle identification number (VIN) at any state police barracks, or local police station.
Instructions to officer/inspector: 1. Make visual inspection of VIN. 2. Sign name and badge number.
A. Owner Information
Last Name
First Name
Middle Initial
Suffix
Business Name (if applicable)
Address
Street
City
Email Address
State
Zip Code
Phone #
B. Vehicle Information
Model Year Make
Model Name
Type
Vehicle ID #
Color
Owner's Signature: _________________________________________________________________________________
C. Certification and Signature
I certify that I visually inspected the above described vehicle on this date ________________________ and found the vehicle identification number to be:
Insert Vehicle Identification Number (VIN)
Is VIN #: Missing Changed Altered Department/Office: _____________________________________________________________ Officer's/Inspector's Signature: ____________________________________________________ Badge #: ______________________________________________________________________
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TTL106_1119
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