Illinois > Secretary Of State > Miscellaneous
Law Enforcement Certification (Motor Vehicle-Odometer) VSD-43.5 - Illinois
| Law Enforcement Certification (Motor Vehicle-Odometer) Form. This is a Illinois form and can be used in Miscellaneous Secretary Of State . |
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Print Reset Save State of Illinois Office of the Secretary of State Law Enforcement Certification VEHICLE INFORMATION Name of Owner(s): 1. ______________________________________________________________________ Last First Middle Initial 2. ______________________________________________________________________ Last First Middle Initial Address of Owner: ______________________________________________________________________ ______________________________________________________________________ City State ZIP Code I hereby certify and affirm that I have made a physical inspection of the vehicle and the information below is true and correct. Vehicle Description: ______________________________________________________________________ Year Make & Model ______________________________________________________________________ Body Style Cylinders Horsepower ______________________________________________________________________ Vehicle Identification Number (For Second Stage Vehicle Use Only) ______________________________________________________________________ Year Make Model Body Style ______________________________________________________________________ Vehicle Identification Number CERTIFICATION INFORMATION (Please Type or Print) Name of Law Enforcement Agency: ______________________________________________________________________ Address: ______________________________________________________________________ Street ______________________________________________________________________ City, State, ZIP Signature of Officer Making Inspection: ______________________________________________________________________ Printed by authority of the State of Illinois. March 2010 8M VSD-43.5 American LegalNet, Inc. www.FormsWorkFlow.com
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