Fillable Printable Form VS-118 - Request for Replacement Inspection Sticker - New York

Form VS-118 - Request for Replacement Inspection Sticker - New York

REQUEST FOR REPLACEMENT INSPECTION STICKER

VEHICLE SAFETY & CLEAR AIR

6 Empire State Plaza

Albany, NY 12228

VS- 118 (10/15)

INSTRUCTIONS:

1. Complete all fields in the “Sticker Information” section. To receive a replacement sticker, all fields must be completed.

2. You must briefly explain why you need a replacement sticker in the space provided below. If the reason is because the

windshield was replaced, you

mustinclude a copy of the receipt for the repair from the shop that replaced it.

3. Include either:

a.A copy of the inspection receipt; OR

b. The remains of the original inspection certificate showing the date of expiration, the sticker serial number, and

the mileage.

4. The fee for a replacement inspection sticker is $2. Enclose a check or money order payable to “Commissioner of

Motor Vehicles”.

Do not send cash.

a.Write the license plate number of the vehicle that needs the replacement sticker in the memo section of your

check or money order.

b. Sign your check or money order.

5. Send this form, completed and signed, with your payment and the items described above to:

NYS DMV Bureau of Consumer and Facility Services

Issuance Unit

P.O. Box 2700

Albany, NY 12220-0700

NOTE: If approved, your replacement sticker will be mailed to the address associated with the vehicle’s registration.

The inspection sticker is a secure document and must be sent only to the individual who registered the vehicle.

Signature of registrant

(Sign name in full) ç

Print name of registrant

Date (Month/Day/Year)

CERTIFICATION

STICKER INFORMATION - All fields must be completed

Briefly explain why you need a replacement inspection sticker:

I certify that the information I have provided on this form is true and complete to the best of my knowledge.

WARNING: Intentionally making a false statement or providing false or misleading information in connection with this

application is a criminal offense that may subject you to criminal prosecution under the Law.

Registrant’s Name (as it appears on the NYS registration)

Serial Number of Original Inspection Sticker (if available)

Odometer Reading at the Time of Last Inspection

Vehicle Plate Number

Daytime Phone No. (Include Area Code)

( )

Date of Last Inspection

Vehicle YearVehicle Make/Model

Reset/Clear