Free Street modified or replica vehicle designation - Wisconsin

STREET MODIFIED OR REPLICA VEHICLE DESIGNATION
MV2855 4/2006
Owner Name(s) - Please Print

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Mail to:

Research and Information Wisconsin Department of Transportation PO Box 8070 Madison WI 53708-8070

Street Modified - Original Year: Replica Vehicle - Year Replicated:
Vehicle Identification Number

Street Address City, State, ZIP Code

Area Code - Telephone Number 7 a.m. - 4:30 p.m.

Make

Body Style

Gross Weight

Street Modified: Vehicle modified from original manufacturer's specifications but still recognizable as the original year and make. Replica Vehicle: A motor vehicle, other than a motorcycle, that is a reproduction of a vehicle originally made by another manufacturer and which consists of a reproduction body that is combined with a new, used, or replica frame and drivetrain. s.341.268(1)(e) Wis. Stats.

Note: If your vehicle is currently titled as reconstructed or homemade, has a WI assigned identification number, and you now wish to title the vehicle by the original identification number, you must contact the State Patrol District nearest you for the completion of form SP4124, Vehicle Identification Report, and a positive identification check. Return this form, completed form SP4124, and the WI assigned identification number with your title to the address above.

Warning: The WI identification number may only be removed by or in the presence of the State Patrol officer.

I (we) certify that the information is true and correct and the vehicle described above meets all of the safety equipment standards of Ch. 347 Wisconsin Statutes and the Administrative Rule that govern vehicle equipment. X
(Owner) (Date)

X
(Owner) (Date)

If you have questions, contact Research and Information at 608-266-1466 or E-mail: [email protected]

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