BODY TYPE CLARIFICATION BODY TYPE CHANGE AFFIDAVIT by gtu20753

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									                 BODY TYPE CLARIFICATION / BODY TYPE CHANGE AFFIDAVIT
                 State Form 39771 (R / 10-96)




                                                     CLARIFICATION OF BODY TYPE AFFIDAVIT
                                                                No Physical Change to Vehicle
                                                            Statement Verifying Use or Vehicle Type

                                                         OWNER INFORMATION (Please Type or Print )
Name of owner


Address (number and street, city, state, ZIP code)




                                                                     VEHICLE INFORMATION
Year                                  Make                                         Model


Vehicle ID number (VIN)




   When vehicle was originally titled / registered the vehicle type was ___________________________ . The use of vehicle now requires the vehicle


   type to be a ____________________________ . There was no physical change to the vehicle. NOTE: Vehicle types are listed on the reverse side.

Please check the reason for the body type change:


        1.    Vehicle was titled in another state and the vehicle type indicator is different than Indiana. NOTE: Vehicle inspection is required if #1
              is checked. Attach a completed Affidavit of Police Officer (State Form 39530).


        2A. The vehicle was titled / registered as a passenger car, but I now use the vehicle primarily to haul persons or property.


        2B. The vehicle was titled and registered as a truck, but is no longer used primarily to haul persons or property.
            (Branch Note: "TK" to "2W" or "4W")


        3.    Other, please explain in detail:




       I / We the undersigned swear or affirm that the information on this form is correct. I / We understand that making a false statement on this form may
       constitute the crime of perjury.
Signature of applicant                                                                                            Date (month, day, year)




                                                        (See reverse side for Body Change Affidavit.)
                                                                      BODY CHANGE AFFIDAVIT
                                                        Physical Change to Vehicle That Changes Vehicle Type
                                                              OWNER INFORMATION (Please Print or Type)
Name of owner


Address of owner (number and street, city, state, ZIP code)




Body type before change


Body type after change


Vehicle year             Model                                                       Make


Vehicle ID number (VIN)


Name of person making change


Address (number and street, city, state, ZIP code)




Date body change completed


        I / We the undersigned swear or affirm that the information on this form is correct. I / We understand that making a false statement on this form may
        constitute the crime of perjury.
Signature of applicant                                                                                             Date (month, day, year)


                                   :
            NOTE TO APPLICANT Former title or certificate of origin, and any bills of sale or documentation supporting change of vehicle type must
            be submitted with this affidavit.
                                                                      POLICE OFFICER INSPECTION
        I hereby certify that I have physically inspected the above vehicle and the body change described above has been completed. I have physically
        inspected the vehicle identification described above. I, the undersigned, swear or affirm that the information on this form is correct. I understand that
        making a false statement on this form may constitute the crime of perjury.
                                                                 INSPECTING OFFICER INFORMATION
Name (printed)


Title                                                                                Department


Telephone number                                          ID number                                                Date of inspection (month, day, year)


Signature




                                                                       VEHICLE BODY TYPE CODES

                            2W       2 Door Wagon                                                              SE       Semi-Trailer
                            4W       4 Door Wagon                                                              CB *     Church Bus
                            2S       2 Door Sedan                                                              SP       Special Purpose Bus
                            4S       4 Door Sedan                                                              VA       Van
                            2H       2 Door Hard Top                                                           JP       Jeep
                            4H       4 Door Hard Top                                                           CN       Convertible
                            TK       Truck                                                                     MH       Mobile Home
                            TR       Trailer                                                                   AT       Off Road Vehicle
                            SB       School Bus                                                                RV       Recreational Vehicle
                            TC       Semi-Tractor                                                              MC       Motorcycle
  * Note: CB is not a valid body type for a vehicle designed to carry less than 10 passengers (exclusive of the driver) regardles of the vehicle's use.
          For example, a van designed to carry seven passengers can never be typed as a CB even if used for church purposes.

								
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