
A L A BA M A DEPA RTM EN T OF R EV EN U E
M OTOR V E H ICL E DIV ISION
M ontgomery, A L 36132
M otor Vehicle Inspection by a Government Official
N O T E: E xamine Public V I N Plate and mak e certain that the rivets are intact and the V I N has not been altered.
Vehicle Identification Number: ___________________________________________________________________________________
Make: ______________________________ Y ear: ______________________________ Model: _____________________________
B ody T ype: ________________ ___________________________ Number of C ylinders: ___________________________________
C olor:________________________________________________ Odometer R eading: _____________________________________
Other Des cription or C omments (if any): ___________________________________________________________________________
____________________________________________________________________________________________________________
I hereby certify that I completed the information above from a physical inspection of the motor vehicle and that all infor-
mation is true and correct.
Name of Official (P rint): _________________________________________________________________________________________
S ignature: ________________________________________________________ Date: __________________________________
Agency: _____________________________________________________________ P hone No.: ______________________________
Agency Address: _____________________________________________________________________________________________
________________________________________________________________________________ Zip C ode: ___________________
MVT 5-10
4/12
P AR T I – V ehic le Ins pection (c omplete in full)
P AR T II – Appointment of Deputy by a L ic ens ing Offic ial
I hereby accept the certification of physical inspection of the motor vehicle as completed above and I appoint this official as
my deputy for the purpose of this physical inspection required of me personally or through any of my deputies
by State
law. I further certify that the vehicle identification number and vehicle description completed above are the same as the
information shown on the application for certificate of title and/ or registration.
S ignature: ________________________________________________________ Date: __________________________________
Licensing Official: __________________________________________ Designated Agent No
.: ________________________________
N O T E: T his form may be provided to owners of motor vehicles that cannot be driven or delivered to the licensing
official’s office for a physical inspection because of the size of vehicle or for other special reasons.
Please instruct the owner to deliver this form and the vehicle to a government official for inspection.
P leas e be reminded that the vehicle to be tit
led or regis tered mus t be located in Alabama.
THIS F OR M MAY B E R E PR ODUC E D
F OR US E B Y
L IC E NS ING OF F IC IAL S
ONLY