Form Mvd 10015 – Fill Out and Use This PDF

MVD-10015

STATE OF NEW MEXICO - MOTOR VEHICLE DIVISION

REV.04/95

AFFIRMATION FOR SPECIALLY CONSTRUCTED

OR RECONSTRUCTED VEHICLE

APPLICANT INFORMATION

NAME

ADDRESS

CITY, STATE, ZIP CODE

VEHICLE INFORMATION

YEAR

MAKE

MODEL

BODY TYPE

ENGINE NUMBER (If Applicable)

VEHICLE (CHASSIS OR FRAME) IDENTIFICATION NUMBER (If Any)

Hasthisvehicleeverbeentitledand/orregisteredinthisoranyotherstate? Ifyes,provideinformationbelow.

YES

NO

STATE

TITLE NUMBER

REGISTRATION NUMBER

IfvehiclewasconstructedbyalicensedNewMexicodismantler,pleaseindicatebelow.

DISMANTLER BUSINESS NAME

BUSINESS LICENSE NUMBER

LIENHOLDER INFORMATION (IF APPLICABLE)

NAME

LIENHOLDER NO. (IF APPLICABLE)

ADDRESS

FILE DATE

CITY, STATE, ZIP CODE

MATURITY DATE

	CONSTRUCTION TYPE
	Thisvehiclewasspeciallyconstructed(new,firsttimeconstruction)withanewshopbuiltor
	homemadechassis.
	Thisvehiclewasreconstructed(rebuilt)usinganexistingfactorymadechassis.

VEHICLE MUST BE TAKEN TO A LOCAL MVD FIELD OFFICE FOR V.I.N. INSPECTION (OR TO HAVE A NEW MEXICO V.I.N. ASSIGNED) AND REQUIRED DOCUMENTATION DESCRIBED ON THE REVERSE SIDE OF THIS FORM MUST BE PROVIDED. IF VEHICLE WILL BE DRIVEN IN FOR INSPECTION OBTAIN A TEMPORARY TRANSPORTATION PERMIT (FORM MVD-10034).

Iherebyaffirmthatallinformationgivenaboveistrueandcorrecttothebestofmyknowledge.

Applicant'sSignature

Date

REQUIRED DOCUMENTATION

SPECIALLY CONSTRUCTED VEHICLES

There are two types of specially constructed vehicles, HOMEMADE and REPLICA. A HOMEMADEvehicleisonebuiltfromscrapmetalorothermaterials,shopbuiltparts(includingthe chassis)andpartsfromothervehiclesbutmayhaveapre-fabricatedbody. AREPLICAvehicleis one made from a pre-fabricated chassis and body kit purchased from a replica, kit car or trailer manufacturer.

NOTE: Fortitlingandregistrationpurposes,“REPLICA”isagenerictermanddoesnotneces- sarilymeanthekitwasdesignedtoresembleaspecifichistoricmodelorclassicbody style.

Inadditiontothisform(MVD-10015)alsoprovidethefollowingdocumentation:

1.InvoicesandBillsofSaleformajorcomponents.

2.Manufacturer’sCertificateofOriginforchassisand/orbody(ifapplicable).

3.WeightCertificate.

4.VehicleEquipmentAffirmation(formMVD-10053).

TheMotorVehicleDivisionwillassigna“NM”prefixVehicleIdentificationNumber. Theyear inwhichthevehiclebecomesfullyassembledandinspectedwilldeterminetheYEAR. Thevehicle MAKEwillbeidentifiedas“HOMEMADE”or“REPLICA” dependinguponthetypeofchassisand body.

RECONSTRUCTED VEHICLES

A reconstructed vehicle is one that is reassembled or rebuilt from existing factory parts (includingthechassis)butmayhaveapre-fabricatedbody.

Inadditiontothisform(MVD-10015)alsoprovidethefollowingdocumentation:

1.CertificateofTitle(forthechassis)properlyassignedtotheapplicantor,ifthevehiclewas reassembled by (or purchased from) a licensed New Mexico Dismantler, a Dismantler’s NotificationandBillofSaleforthechassis.

2.InvoicesandBillsofSaleforothermajorcomponents.

3.Manufacturer’sCertificateofOriginforthebodykit(ifapplicable).

4.WeightCertificate.

5.VehicleEquipmentAffirmation(formMVD-10053).

Thefactorychassiswilldeterminetheyear,makeandprimaryVehicleIdentificationNumber asindicatedonthechassistitle. TheMotorVehicleDivisionwillalsoassigna“NM”prefixVehicle Identification Number to be used as a secondary V.I.N.. The vehicle model will be identified as “REBUILT”.