Fillable Printable Hmmwv Affidavit From Manufacturer

Hmmwv Affidavit From Manufacturer

MVR-622

Rev. 6-17

HMMWV Affidavit from Manufacturer

MAKE________________________________________________

YEAR/MODEL ________________________________________

VIN__________________________________________________

This form must be signed by the manufacturer or seller

I attest that the above described HMMWV complies with all applicable federal motor

vehicle safety standards for vehicles designed for highway use.

I affirm under penalty of perjury and/or punishment pursuant to N.C.G.S. 20-112, that the

foregoing information is based upon my personal knowledge and is true and accurate

to the best of my knowledge.

Signature /Title___________________________________________________

Date ____________________________________________________________

Date ________________ County ___________________________ State ____________________

I certify that the following person(s) personally appeared before me this day, each

acknowledging to me that he or she voluntarily signed the foregoing document for the

purpose stated therein and in the capacity indicated:

________________________________________________________________ (name(s) of principal(s)).

Notary Signature______________________________________________________________________

Notary Printed or Typed Name ________________________________________________________

(SEAL)

My Commission Expires ___________________

North Carolina Division of Motor Vehicles

North Carolina General Statute 20-4.01(12h) defines a High-Mobility Multipurpose Wheeled Vehicle

(HMMWV) as a four-wheel drive vehicle produced for military or government use and commonly

referred to as a "HMMWV" or "Humvee".