DMV-1B

Rev. 3/91

STATE OF WEST VIRGINIA

DEPARTMENT OF TRANSPORTATION

DIVISION OF MOTOR VEHICLES

1900 KANAWHA BOULEVARD EAST, BUILDING 3

CHARLESTON, WEST VIRGINIA 25317

VERIFICATION OF VEHICLE IDENTIFICATION NUMBER

(This form may be completed by any law enforcement officer)

THIS IS TO CERTIFY THAT I HAVE PHYSICALLY EXAMINED THE VEHICLE DESCRIBED HEREIN:

SECTION A

Make Model Year Body Style Title No. State

Owner of the vehicle

(Name)

(Address) (City) (State) (Zip)

I found the vehicle identification number to be:

I FURTHER CERTIFY THAT THE VEHICLE IDENTIFICATION NUMBER WAS NOT OBTAINED FROM ANY REGISTRATIONS OR DOCUMENTS RELATIVE TO THIS VEHICLE.

Authorized Agency

Signature of Officer

Badge/Unit Number Date

*If the public vehicle identification number is missing and a vehicle identification plate is required, Section B must also be completed and signed ($5.00 fee required).

SECTION B

I hereby request a replacement vehicle identification plate be issued for the above vehicle.

Reason for Request

(lost, stolen, destroyed, altered, etc.)

I hereby certify the confidential number is:

If the confidential number does not exist, a West Virginia vehicle identification number will be issued.

Authorized Agency

Signature of Officer

Badge/Unit Number Date

This form must be executed with a typewriter or printed with ink.

Any alterations or erasures will void this certification.