Vehicle Verification Form
Officer Name
First Name
Last Name
Vehicle Type
Vehicle#
Mileage
Please supply the necessary information.
Rows
Pass
Fail
Repair Ticket Made or not?
Specify
Headlamps
1
2
3
Taillights
4
5
6
Brake Lights
7
8
9
Air Bag Lights
10
11
12
Turn Signals
13
14
15
Dash Instruments
16
17
18
Inside Dome Light
19
20
21
Brakes
22
23
24
Exhaust System
25
26
27
Mirrors
28
29
30
Inside Emergency Light
31
32
33
Control Boxes
34
35
36
Computer
37
38
39
Date
*
 /
Month
 /
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Should be Empty: