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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