Free MV2673 - Wisconsin

MV2673 7/2004 s.342.07 Wis. Stats. This form must be completed and submitted when vehicle is inspected. See below for major parts list.
Owner Name (Please Print) Vehicle Year, Make

MAJOR PARTS STATEMENT Repaired Salvage Vehicle or Homemade

Wisconsin Department of Transportation

Salvage Title Number

From (State)

VIN (Vehicle Identification Number)

PART TYPE

YEAR

MAKE

PART NUMBER

VIN OF VEHICLE FROM WHICH PART WAS OBTAINED

RECEIPT ATTACHED YES NO

I have not changed any of the major parts of this vehicle. I have changed the major parts listed above. Attach a bill of sale for each part listed. See below for definition.

(Date) (Owner) Major Parts "Part" means any component of a motor vehicle which may be separated from the vehicle or any replacement for such a component. Major parts as defined in s.943.23(1)(b) Wis. Stats. include engine, transmission, each door, hood, grille, each bumper, each front fender, deck lid, tailgate or hatchback, each rear quarter panel, trunk floor pan, frame or supporting structure which serves as the frame, any part not listed which has a value exceeding $500.00, any motorcycle part not listed under this subsection which has a value exceeding $150.00 Definition: "Bill of Sale" means a document describing the sale of a vehicle or a part of a vehicle, containing a description of the transaction, including the name of the major part; the model year, make and identification number of the vehicle from which the major part was obtained; the date of the transaction; the signature of the person selling or disposing of the major part; the name of the customer and the amount paid for the major part. If the vehicle from which a major part was obtained is not known or determinable by the seller, the bill of sale shall identify the seller and state that the source is unknown.

X

Agent Assignment If you are represented by an agent when your vehicle is inspected, complete the information below.
The following person is appointed to act as my agent for the inspection of the vehicle described below. My agent is required to sign the inspection statement when inspection is completed.
Agent Name

Vehicle Year, Make

Vehicle Identification Nmber

Distribution: 1-WDOT DMV; 2-Owner; 3-Officer

X

(Owner)

(Date)