Vehicle Inspection Form Indiana

INDIANA STATE VEHICLE INSPECTION AND VERIFICATION FORM

PURPOSE: This form is intended to satisfy the requirements for a physical inspection of a vehicle as mandated by the Indiana Bureau of Motor Vehicles (BMV) for title applications, salvage restorations, or registration purposes.

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I. VEHICLE IDENTIFICATION DATA

To be completed by the Inspector.

Vehicle Identification Number (VIN): [_________________________________]

Make: [________________] Model: [________________] Year: [______]

Body Style: [________________] Color: [________________]

Odometer Reading: [________________] Fuel Type: [________________]

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II. REGISTERED OWNER / APPLICANT INFORMATION

To be completed by the Applicant.

Full Legal Name: [__________________________________________________]

Residential Address: [__________________________________________________]

City: [________________] State: IN Zip Code: [__________]

Driver’s License / ID Number: [_________________________________]

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III. INSPECTION FINDINGS

To be certified by an Indiana law enforcement officer, licensed dealer, or authorized BMV inspector.

1. VIN Location(s) Verified: [ ] Dashboard [ ] Door Jamb [ ] Engine Block [ ] Frame [ ] Other: [__________]

2. Physical Condition: [ ] Roadworthy [ ] Non-Roadworthy [ ] Salvage/Rebuilt

3. Equipment Compliance Check:

• Headlights/Taillights: [ ] Functional [ ] Non-Functional
• Turn Signals: [ ] Functional [ ] Non-Functional
• Brake System: [ ] Functional [ ] Non-Functional
• Tires/Steering: [ ] Functional [ ] Non-Functional

Inspector Remarks/Discrepancies: [__________________________________________________________________________] [__________________________________________________________________________]

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IV. CERTIFICATION AND AFFIDAVIT

I, the undersigned inspector, hereby certify under penalty of perjury that I have personally inspected the vehicle described above. I have verified the VIN and confirmed that the information provided herein is true, accurate, and complete to the best of my knowledge and professional observation.

Inspector Name (Printed): [_________________________________]

Inspector Agency/Business: [_________________________________]

Badge/License Number: [_________________________________]

Date of Inspection: [_____/_____/20____]

Signature of Inspector: _______________________________________

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V. APPLICANT ATTESTATION

I, the undersigned applicant, hereby certify that I am the legal owner or authorized agent of the vehicle described above and that the information provided is true and correct. I understand that any false statement made on this document may result in the denial of registration or title, and may lead to criminal prosecution under Indiana law.

Applicant Signature: _______________________________________

Date: [_____/_____/20____]

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Form intended for use within the jurisdiction of the State of Indiana. Ensure compliance with Indiana Code Title 9 regarding Motor Vehicles.