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MVD 11268

This document is an affidavit form from the New Mexico Taxation & Revenue Department for vehicle owners to declare either non-use of a vehicle for a period of time, or that an out-of-state vehicle is insured according to New Mexico's minimum liability requirements. The form collects owner and vehicle information. For non-use, the owner initials a box and provides anticipated non-use dates not exceeding one year. For out-of-state insurance, the owner initials a box and provides their insurance company information and a copy of their insurance card showing liability limits. The owner affirms the statements are true under penalty of perjury.

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245 views1 page

MVD 11268

This document is an affidavit form from the New Mexico Taxation & Revenue Department for vehicle owners to declare either non-use of a vehicle for a period of time, or that an out-of-state vehicle is insured according to New Mexico's minimum liability requirements. The form collects owner and vehicle information. For non-use, the owner initials a box and provides anticipated non-use dates not exceeding one year. For out-of-state insurance, the owner initials a box and provides their insurance company information and a copy of their insurance card showing liability limits. The owner affirms the statements are true under penalty of perjury.

Uploaded by

Damon Alfaro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MVD–11268

REV. 10/11 New Mexico Taxation & Revenue Department, Motor Vehicle Division

AFFIDAVIT OF NON-USE OF VEHICLE


(or)
AFFIDAVIT OF OUT-OF-STATE VEHICLE INSURANCE
Owner Information
Name (last, first, middle initial) Date of Birth

Address Phone Number

City, State, ZIP Code Driver’s License Number and State

Vehicle Information
Make Model Year

Plate Number Vehicle Identification Number (VIN)

Non-Use Information
Please initial box

The vehicle identified above is not being operated for reasons that may include but are not limited to military
deployment, mechanical issues, and storage or seasonal usage. Please enter anticipated non-use dates below.

From: To:

** The NON-USE portion of this affidavit is only valid for a maximum of ONE YEAR.
** A new Affidavit of Non-Use of Vehicle MUST be completed each year that the vehicle will not be driven.

Out-of-State Information
MINIMUM MANDATORY LIABILITY LIMITS § 66-5-208: $25,000 Bodily injury or death of one person in any one accident
$50,000 Bodily injury or death of two or more persons in one accident
$10,000 Destruction of property of others in any one accident
Please initial box

I currently have insurance coverage in compliance with the New Mexico Mandatory Financial Responsibility Act,
§§ 66-5-201 through 66-5-239 NMSA 1978.

Insurance Company Policy Number

Phone Number Effective Dates to

Note: You MUST attach a copy of a current insurance card and declaration page containing liability limits.
** The OUT-OF-STATE portion of this affidavit is only valid during the effective dates of your insurance policy.
** A new Affidavit of Out-of-State Vehicle Insurance MUST be completed each time the policy renews.

Affirmation
I swear or affirm under penalty of perjury that the above statements are true and correct.

Printed Name

Signature Date

A new affidavit must be completed every time a vehicle status changes or, at a minimum, annually.
 Vehicles registered and operated in New Mexico MUST have insurance coverage that meets the minimum liability requirements
of the New Mexico Mandatory Financial Responsibility Act, §§ 66-5-201 through 66-5-239 NMSA 1978.
 Bona fide New Mexico residency is required for vehicle registration (§ 66-3-4 NMSA 1978).

Please return COMPLETED affidavit and ALL required documentation to the New Mexico Insurance Identification Database (IIDB).
Mail to: P.O. Box 30147, Albuquerque, NM 87190-0147 OR FAX to: 505-243-6605
For more information, please call the IIDB toll-free at 866-891-0665.

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