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Umber and Street) (City or Town) (State) MANUFACTURER / ALTERER ADDRESS OF MANUFACTURER / ALTERER (Zip Code) LICENSE NUMBER (Number and Street) (City or Town) (State) (Zip Code) MAKE MODEL YEAR VEHICLE IDENTIFICATION NUMBER (VIN) SIGNATURE OF OWNER DATE SIGNED X OLD GVWR OLD AXLE WEIGHTS GAWR//FRT GAWR 2nd AXLE GAWR 3rd AXLE GAWR 4th AXLE GAWR 5th AXLE NEW GVWR NEW AXLE WEIGHTS GAWR//FRT GAWR 2nd AXLE GAWR 3rd AXLE GAWR 4th AXLE GAWR 5th AXLE OLD SEATING CAPACITY NE.

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