VTR-270

STATEMENT OF (Rev. 5/2007)

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PHYSICAL INSPECTION

I hereby certify that:

I have made a physical inspection of the vehicle described below.

I was unable to obtain a pencil tracing of the vehicle identification number but the vehicle
identification number shown below corresponds with the vehicle identification number
on the vehicle.

Year Make Body Style

Vehicle Identification Number (as shown on vehicle)

Printed Name of Owner/Company

Signature of Owner or Agent

Date Signed:

WARNING: Transportation Code, §501.155, PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED
STATEMENT OR APPLICATION IS A THIRD-DEGREE FELONY.

TEXAS DEPARTMENT OF MOTOR VEHICLES

VEHICLE TITLES AND REGISTRATION DIVISION
AUSTIN TX 78779-0001

Online Form at www.txdmv.gov

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