TITLE 92: TRANSPORTATION
CHAPTER I: DEPARTMENT OF TRANSPORTATION
SUBCHAPTER e: TRAFFIC SAFETY (EXCEPT HAZARDOUS MATERIALS)
PART 448 OFFICIAL TESTING STATIONS
SECTION 448.APPENDIX I DEFECTIVE, MUTILATED OR REPLACEMENT CERTIFICATE OF SAFETY REPORT


Section 448.APPENDIX I   Defective, Mutilated or Replacement Certificate of Safety Report

 

ILLINOIS DEPARTMENT OF TRANSPORTATION

VEHICLE INSPECTION SECTION

2300 S. Dirksen Parkway

Springfield, Illinois 62764

DEFECTIVE, MUTILATED, OR REPLACEMENT CERTIFICATE OF SAFETY REPORT

Instructions:

1.  Staple not more than four certificates to each form. Use additional copies if necessary.

 

2.  Use #2 pencil and complete a Vehicle Inspection Report for each replaced Certificate of Safety.

 

3.  Code in bubble in blank box at end of glazing field on VIR.

Mailing Instructions:

Complete one or more copies and return with monthly report (ST-2) to the VIS/DOT. (As shown in the above address.)

 

STAPLE

CERTIFICATE

HERE

 

#1

 

Record complete serial

number before removing

from glass.

 

 

 

 

 

STAPLE

CERTIFICATE

HERE

 

#2

 

Record complete serial

number before removing

from glass.

 

 

 

 

C/S No.

 

 

C/S No.

 

 

 

 

 

STAPLE

CERTIFICATE

HERE

 

#3

 

Record complete serial

number before removing

from glass.

 

 

 

 

STAPLE

CERTIFICATE

HERE

 

#4

 

Record complete serial

number before removing

from glass.

Remarks C/S #1

Remarks C/S #2

Remarks C/S #3

Remarks C/S #4

C/S No.

 

 

C/S No.

 

 

 

 

Vehicle Inspection

Date

 

 

Prepared by (print)

 

 

Station No.

 

 

Signature

 

 

SVI-1280 (Rev. 1-76)

 

 

ADDITIONAL INFORMATION REQUIRED

 

If you submit your rejected vehicle to any testing station other than the one which first rejected it, the you must:

 

 

1.

Pay appropriate test fee (first retest is free only at original testing station).

 

 

2.

Present the second testing station with your blue copy of the Inspection Report (VIR-1) from the original testing station.

 

 

3.

Notify the Vehicle Inspection Section in writing by completing all of the items on the lower part of this notice.

 

 

4.

After the second safety test is completed, detach the lower portion of this notice, affix a stamp, enter your return address, and mail immediately.

 

 

 

REMEMBER Only use this notice if you do not return your rejected vehicle to the original testing station for retest.

 

NOTICE TO THE ILLINOIS DEPARTMENT OF TRANSPORTATION–VEHICLE INSPECTION SECTION

 

In compliance to the legal requirements of Section 13-109 of the Vehicle Code, I submit that the following information in writing regarding my rejected vehicle which was safety tested as a second or different testing station other than the first testing station which rejected my vehicle.

 

FIRST TESTING STATION

DESCRIPTION OF MY VEHICLE

SECOND TESTING STATION

Name

 

Truck

Bus

Trailer

Name

 

Address

 

Tractor

Semitrailer

Address

 

City & Zip

 

Year & Make

 

City & Zip

 

Date of Test

 

V.I.N. (Serial No.)

 

Date of Test

 

Cause of Rejection (Defects)

Fleet No.

 

Certificate of Safety Number Issued (If any)

 

License No.

 

 

 

 

Repairs Made by

 

Approved

 

Date Repairs Completed

 

Rejected

My Name (Print)

 

(Company, If owner)

 

Address

 

City & Zip Code

 

Signature

 

FAILURE TO COMPLY WITH THE LAW REGARDING REJECTED VEHICLES WILL SUBJECT THE OWNER TO ARREST

SV1-1312 (Rev. 9/76)