Fillable Printable Form VS-1075 - Inspection Rejection/Advisory Notice - New York

Form VS-1075 - Inspection Rejection/Advisory Notice - New York

Heavy Vehicles Only rejected for:

q Cracked or Bent Wheels q Valve Stems

7. Mirror(s) rejected for:

q Mounting/Adjustment q Cracked/Broken/Discolored q Missing

6. Glass rejected for:

q Cracks and/or Stars q Unapproved Glass q Missing Windshield

4. Steering, Suspension, Front End and Chassis/Frame rejected for:

q Steering Wheel Play q Springs or Torsion Bars q Power Steering Unit q Chassis/Frame

q Steering Linkage q Front End Assembly q Shock Absorbers or Mounting (Broken/Missing)

Failed Inspection Items Are Noted Below

VS-1075 (9/15)

Motorist: If you have a complaint about the inspection performed on your vehicle,

you may phone the New York State Department of Motor Vehicles at (518) 474-8943.

I certify that this vehicle fails the

New York State inspection for

the items noted above

- __________________________________________________________________

(Certified Inspector Signature and Number)

THERE IS NO SALES TAX ON INSPECTION FEES

INSPECTION REJECTION/ADVISORY NOTICE

1. Service Brake rejected for:

q Brake Equalization

q Wheel Cylinders

q Hoses and Lines

q Master Cylinder

2. Parking Brake rejected for:

q Operation q Missing Components q Not Independent from Service Brakes

3. Tires rejected for:

q Tread Wear q Condition q Restricted Use Tires

5. Lights/Reflectors rejected for:

q Headlight Operation q Backup Lights q Hazard Warning Lights q Other Lights

q Tail Lights q Directional Signals q Brake Lights q Marker/Clearance/Reflectors

8. Wipers (windshield only) rejected for:

q Missing q Operation q Blade Condition

9. Horn rejected for:

q Operation

10. Seat Belts rejected for:

q Number of Belts q Buckling q Anchoring q Operation

11. Fuel Leaks rejected for:

q Fuel System Leaks

12. Hitch/Coupling rejected for: q Cracks or Broken Welds and/or Bolts q Looseness in Hitch Attachment

13. Chassis/Frame rejected for:

q Bent or Cracked q Deteriorated due to Rust

14. Wheels and Fasteners rejected for:

q Broken or Missing Wheel Fasteners

15. Exhaust System of Heavy Vehicles and Motorcycles ONLY rejected for:

q Faulty Exhaust System

18. Diesel Emissions Test

Test Limit

1991 & newer 1974-1990 1973 & older

q 40% q 55% q 70%

Test Readings _________________

16. Emergency Breakaway System of Trailers Over 10,000 lbs. Only rejected for:

q System Missing q Inoperative

17. Advisory Notification — Vehicle is NOT rejected for these items:

q Air Bag Readiness Light q Tire Pressure

q Pedal Reserve

q Brake Fade

q Power Brake Unit

q Drum Brake Lining

q Calipers

q Disc Brake Pads

q Brake Drum

q Brake Rotor

q Gauge q Warning Device

q Adjustment q Air Leaks

For Vehicles Over 10,000 Pounds

GVW Only

Facility ID

Number

Repairs needed to pass inspection can be done at any location of the motorist’s choice. After the repairs are completed, the vehicle must

be reinspected at any official inspection station. If the vehicle is presented for reinspection to the same station within 30 days, the station

may only perform the portion of the inspection (safety or emission) that the vehicle was failed for, and may only charge the fee for that

portion. If the vehicle is presented to a different station or if it has been over 30 days, then a full inspection must be performed.

A reinspection fee may not be charged unless the vehicle is removed from the station by the motorist, and is later returned for reinspection.

License Plate Number and State (or VIN)

Date:____________________

Vehicle Year Vehicle Make Odometer Reading