Free Driver training vehicle record - Wisconsin

DRIVER TRAINING VEHICLE RECORD
Wisconsin Department of Transportation MV3264 8/2007 s.343.72 Wis. Stats.

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Submit proof of insurance on the vehicle identified below to the Wisconsin Department of Transportation. Hold minimum insurance of not less than $500,000 because of bodily injury to or death of one person in any one accident and, subject to that limit for one person, to a limit of not less than $500,000 because of bodily injury to or death of 2 or more persons in any one accident and, if the accident has resulted in injury to or destruction of property, to a limit of not less than $50,000 because of injury to or destruction of property of others in any one accident. The Driver Training School must make a copy of this completed form for their records and send the original to: WI DOT Driver Training School Program, PO Box 7920, Madison, WI 53707-7920.

Section A - Registration ­ School completes this section:
+ When vehicles are added to the fleet; + If the vehicle is less than 3 years old OR the mileage is less than 100,000.
Driver School Name Driver School Address Vehicle Year Vehicle Identification Number Make Model License Plate Number Mileage Driver School Identification Number

Section B - Inspection
DMV Representative completes this section when vehicle is added to fleet or upon DTS Coordinator request. Vehicle inspection requirements are defined by s.343.72(10)(11)(12) Wis. Stats. and Trans. 105.06(11) (a), (b) Wis. Adm. Code.

Right Outside Mirror Replacing Vehicle
Year Make

Sign Visible from Rear of Vehicle
Vehicle Identification Number

Dual Brake

(Examiner Signature / Number)

(Date)

Section C - Certification ­ Mechanic completes this section, only when vehicle is 3 years old or more and/or has more than
100,000 miles, Trans. 105.06(11) Wis. Adm. Code. Each such vehicle shall be inspected annually. The school is encouraged to have the annual inspection just prior to the month of the expiration of your driver school license. The definition of "motor vehicle repair shop" is a natural person, corporation, partnership or other business association or entity engaged in the motor vehicle repair business, but does not include a shop that repairs motor vehicles for a single business entity or for 2 or more entities subject to common control.
Mechanic Name Service Facility Name Service Facility Address

The following equipment / components must be in working order: + Headlamps, both high and low beams; + Tail lamps, front and rear turn signals, side lights, and brake lights; + Hazard warning lamps; + License plate lamp; + Mirrors, both inside and outside; + Driver and passenger door latches and locks; + Brakes, both foot and parking brakes; + Driver and passenger restraints, including air bags if so equipped; + Windshield, rear window, front, and side windows;

+ Horn; + Dual-Control brake; + Tires and rims; + Steering and suspension; + Exhaust system; + Speedometer; + Bumpers; + Frame or unibody.

I certify that I inspected the vehicle identified on this form. The vehicle meets or exceeds safety standards.
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(Mechanic Signature)

(Date)