Affidavit for Inspection of an Antique Vehicle - BIPAC

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APPLICATION FOR CERTIFICATE OF TITLE l STATE OF INDIANA l BUREAU OF MOTOR VEHICLESState Form 44049 (R4 / 3-02)Approved by State Board of Accounts 2002TO BE COMPLETED BY A POLICE OFFICER, BMV OFFICIAL OR BMV CERTIFIED DEALER SIGNEEFOR OUT OF STATE TITLES. I HEREBY CERTIFY THAT I PERSONALLY EXAM-INED THE FOLLOWING VEHICLE AND FIND THE IDENTIFICATION NUMBER TO BE AS FOLLOWS.VEHICLE IDENTIFICATION NUMBER11 13 17YR. MAKE MODEL TYPE DATEI/WE THE UNDERSIGNED SWEAR OR AFFIRM THAT THE INFORMA-TION ENTERED ON THIS FORM IS CORRECT. I/WE UNDERSTANDTHAT MAKING A FALSE STATEMENT ON THIS FORM MAY CONSTI-TUTE THE CRIME OF PERJURY. FUTHERMORE, I/WE AGREE TOINDEMNIFY AND HOLD HARMLESS THE INDIANA BMV FROM ANYLIABILITY ARISING FROM THIS TRANSACTION.X __________________________________________________________INSPECTOR'S PRINTED NAME & TITLECITYX __________________________________________________________DATE: ______________________________________________________INSPECTOR'S SIGNATURE1.TITLE NUMBERBADGE, BRANCH ORDEALER PLATE NO.BRANCH NO. INVOICE NO.The law requires that you apply for Certificate of Title within thirty-one days from the date of purchase of amotor vehicle. There is a delinquent fee for failure to do so. Attach Certificate of Title assigned by seller. On endorsedTitles, liens must be released. Supporting documents surrendered with this application cannot be returned to the applicant.*In accordance with Federal Code 383.BMV USE ONLY2.*SOC. SEC./FEDERAL I.D.NO.APPLICANT'S NAMEBMV USE ONLY3.STREET ADDRESSCITY STATE ZIP CODE4.VEHICLE I.D. NUMBERVEH.YEAR VEH. MAKE VEH. MODEL NO. VEH TYPE ODOMETER5.FORMER TITLE NUMBERPURCHASE DATE LIEN SPEED PICK UP MAIL DEALER NO. BMV USE ONLY6.FIRST LIEN'S NAME OR SPECIAL MAILING ADDRESSSTREET ADDRESS7.CITYSTATE ZIP CODE BMV USE ONLY8.SECOND LIEN'S NAMESTREET ADDRESS9.CITYSTATE ZIP CODE LICENSE NUMBER LICENSEYEARFORMSUSEDBMV USE ONLY10.GROSS RETAIL & USE TAX AFFIDAVIT - I/WE HEREBY CERTIFY THAT SALES OR USE TAX ON THIS VEHICLE WAS PAID AS INDICATED BELOW.SELLING PRICE LESS TRADE-IN * AMOUNT SUBJECT TO TAX AMOUNT OF TAX DEALER BRANCH EXEMPT IF EXEMPTPLACE PARA.#$ $ $ $*Your Social Security number / Federal I.D. number is being requested by this agency under IC 4-1-8-1. Disclosure is manadatory and this document cannot be processed without it.APPLICANT RESPONSIBLE FOR ACCURACY OF INFORMATIONAPPLICATION FOR CERTIFICATE OF TITLE l STATE OF INDIANA l BUREAU OF MOTOR VEHICLESBUREAU - TO BE MAILED WITH TITLE REPORT
AFFIDAVIT OF POLICE OFFICERPhysical Inspection of an Indiana Resident's WATERCRAFTState Form 39530 (R4 / 12-96)INSTRUCTIONS:Use reverse side for vehicle.Indiana Code does not permit watercraft inspections by watercraft dealers.NOTE: There are no provisions in the Indiana Code for assessing an inspection fee.NOTE TO LAW OFFICER1. A Title or Certificate of Origin does not have to be present to complete this affidavit.2. You are required to physically inspect the watercraft to verify the existence and condition of the Hull Identification Number.Name of ownerAddress of ownerWATERCRAFT INFORMATIONYearI, the undersigned law enforcement officer, hereby swear or affirm that I have personally examined the watercraft described asfollows:MakeModelLengthIndiana Registration NumberHull Identification Number (HIN)ft.NOTE TO LAW OFFICERTHE BMV WILL NOT ACCEPT THIS AFFIDAVIT IF THE INFORMATION REQUESTED IN THIS BOX IS NOT COMPLETE AND LEGIBLE.Printed name of inspecting officerTitle of inspecting officerName of departmentCityStateID numberTelephone number( )I swear or affirm that the information I have entered on this form is correct. I understand that making a false statement on thisform may constitute the crime of perjury.Signature of inspecting officerDate signed (month, day, year)
Page 1 and 2: INDIANADefinitionsAntique Motor Veh
Page 3 and 4: $5. The officer must fill out a for
Page 5 and 6: Year Of Manufacture Plate ProgramYo
Page 7 and 8: From Indiana Administrative Code:TI
Page 9 and 10: 140 IAC 6-1-5 Body change titleTITL
Page 11 and 12: From Indiana Statutes:Title 9 Motor
Page 13 and 14: provided in this article for obtain
Page 15 and 16: 9-22-3-1. Applicability of chapter.
Page 17 and 18: Title 9 Motor VehiclesArticle 22 Ab
Page 19 and 20: Title 9 Motor VehiclesArticle 22 Ab
Page 21 and 22: egistration of the antique motor ve
Page 23 and 24: Title 9 Motor VehiclesArticle 29 Fe
Page 25 and 26: Title 9 Motor VehiclesArticle 29 Fe
Page 27 and 28: 9-18-14-1. Registration of military
Page 29 and 30: From Indiana Administrative Code:AR
Page 32 and 33: Title 9 Motor VehiclesArticle 19 Mo
Page 34 and 35: Title 9 Motor VehiclesArticle 19 Mo
Page 36: From Indiana Administrative Code:Th
Page 41: APPLICATION FOR SPECIAL IDENTIFICAT

Affidavit for Inspection of an Antique Vehicle - BIPAC

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