Get TX VTR-61 2009

Form VTR-61 Rev. 11/09 Page 1 of 2 Rebuilt Vehicle Statement TYPE OR PRINT Instructions w All information must be complete. 155 PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED DOCUMENT IS A THIRD-DEGREE FELONY. Form VTR-61 Rev. 11/09 IF THE VEHICLE HAS BEEN REBUILT RECONSTRUCTED OR ASSEMBLED FROM COMPONENT PARTS COMPLETE THE FOLLOWING Component Part Attach evidence of ownership bill of sale and/or title Origin Of Component Parts/Purchased From Name Address Required Engine Frame Body v Specify location of component parts replaced Right RT Left L Front F Rear R Right Front R F Left Front L F Right Rear R R Left Rear L R Submit any bills of sale for If Available Transmission Fender S v Hood Door S v Bumper S v Quarter Panel S v Tailgate/Hatchback/Deck Lid Pickup Cargo Box Truck Less Than One Ton Truck Cab Roof Or Floor Pan Passenger Vehicle If Separate From Body Rebuilder Statement w rebuilt repaired reconstructed or assembled the vehicle described on page 1. w The vehicle owner or authorized agent must complete the Owner Statement below. w The person who repaired rebuilt reconstructed or assembled the vehicle must complete the information on page 2 if component parts were used* w If rebuilt by the owner and component parts were used the owner must complete both the Owner Statement below and the Rebuilder Statement on page 2. w Pages 1 and 2 of this statement must be submitted with your title application* Vehicle Information Year Make Model Vehicle Identification Number Body Style Document/Title If Applicable Inspection Information An authorized inspection station must inspect the vehicle after it has been rebuilt not required for title only transactions Expiration Date Date of Inspection Explanation of Repairs Explanation by rebuilder owner or person who rebuilt the vehicle as to what was done to assemble rebuild reconstruct or alter the vehicle for which title is sought IF COMPONENT PARTS HAVE BEEN USED PAGE 2 MUST BE COMPLETED. Owner Statement This statement is to certify that w I am the legal and rightful owner of the vehicle described above. w The vehicle has been rebuilt repaired reconstructed or assembled* w The vehicle identification number VIN disclosed is the same as the VIN affixed to the motor vehicle. Owner s Name Owner s Signature Mailing Address Date City State Zip WARNING TRANSPORTATION CODE 501. w purchased or came into possession of all the component parts listed above in a legal and lawful manner and in accordance with the provisions of Transportation Code Chapter 501. w The vehicle owner or authorized agent must complete the Owner Statement below. w The person who repaired rebuilt reconstructed or assembled the vehicle must complete the information on page 2 if component parts were used* w If rebuilt by the owner and component parts were used the owner must complete both the Owner Statement below and the Rebuilder Statement on page 2. w Pages 1 and 2 of this statement must be submitted with your title application* Vehicle Information Year Make Model Vehicle Identification Number Body Style Document/Title If Applicable Inspection Information An authorized inspection station must inspect the vehicle after it has been rebuilt not required for title only transactions Expiration Date Date of Inspection Explanation of Repairs Explanation by rebuilder owner or person who rebuilt the vehicle as to what was done to assemble rebuild reconstruct or alter the vehicle for which title is sought IF COMPONENT PARTS HAVE BEEN USED PAGE 2 MUST BE COMPLETED. .