STATE OF WYOMING
INSPECTION AND CERTIFICATION OF CORRECT "VIN" NUMBERS
APPLICATION TO COUNTY CLERK FOR MOTOR VEHICLE CERTIFICATE OF TITLE
MOBILE HOME CERTIFICATE OF TITLE OR NON-RESIDENT NON-TRANSFERABLE TITLE
Proof of Ownership Must Accompany Application

Date Issued ______________
MAKE YEAR VEHICLE IDENTIFICATION NUMBER BODY STYLE FUEL NEW USED
-
FACTORY PRICE STATE PRIOR TITLE NO. SELLER ODOMETER PURCHASE DATE
-

NAME OF OWNER ______________________________________________________________
ADDRESS ___________________________________ CITY ______________ STATE _________
SELLERS ADDRESS ____________________________ CITY ______________ STATE _________

VEHICLE SUBJECT TO THE FOLLOWING LIENS AND NO OTHERS
Kind Amount Date In Favor of Address
I HEREBY SWEAR OR AFFIRM under penalty of perjury that all information on this application for INSPECTION AND CERTIFICATION OF CORRECT "VIN" NUMBERS AND/OR APPLICATION FOR TITLE is true and correct and that I am lawfully applying for a Wyoming Title. I further warrant that said vehicle is owned by me (us) and is subject to the liens shown and none other.

I also certify to the best of my knowledge that if the vehicle is a mobile home, all taxes due on the mobile home for the preceding and current year have been paid and in the event that taxes have not been paid, I acknowledge that I/we may be responsible for the taxes due for the preceding and current year.

Subscribed and sworn to before me by ________________________________________________________

(Signature of Applicant)
this _______________ day of ___________________ 20___ ____________________________________

County Clerk or Deputy

AFFIDAVIT OF INSPECTION AND 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 duly 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 Department. ___________ County Sheriff's Office. ___________ Highway Patrol.

Make __________________________ Year ____________ VIN _________________________________

At the request of the 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.

Officer's Name _____________________________________ Badge # _____________________________

(Print or Type)

Location _________________________________________ Phone # _____________________________

(Name of Law Enforcement Agency)

Signature _________________________________________ Date _______________________________
MV-300A (1-96)

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