Homepage / Blank Mv 427 Penndot Form

Misconceptions

Misconception 1: The MV-427 form can be used for both safety and emission inspections.

This is incorrect. The MV-427 form is designated specifically for safety inspections. If you are applying for both safety and emission inspections, you must complete separate forms—one for safety and another for emissions.

Misconception 2: You can submit the application packet with incomplete information.

In reality, submitting an incomplete packet will result in rejection. The Pennsylvania Department of Transportation (PennDOT) requires all items listed in the application checklist to be included for the application to be processed.

Misconception 3: Only the owner needs to sign the application.

This is not true. If someone other than the owner or a corporate officer is responsible for operating the business, that individual must also sign the application. This ensures accountability and compliance with regulations.

Misconception 4: A single utility bill is sufficient for the application.

Applicants must provide copies of the most recent electric and phone bills. This helps verify the operational status of the inspection station and confirms the business address.

Misconception 5: You can use a post office box as your business address.

This is a misunderstanding. The application requires a physical street address. If you wish to receive mail at a different address, you can specify that in the mailing address section, but the business address must be a physical location.

Misconception 6: The insurance requirement is flexible and can be adjusted based on personal preference.

In fact, a certificate of liability insurance or a bond of at least $10,000 is mandatory. This is to ensure that there is compensation available for any damage that may occur during inspections.

Misconception 7: You can apply for a new inspection station without a Federal ID number or State Sales Tax number.

This is misleading. The application requires you to provide either a valid Federal ID number or a State Sales Tax number. If you are in the process of obtaining these numbers, you can indicate that on the form.

Misconception 8: The MV-427 form is only for new inspection stations.

While it is used for new applications, the form is also applicable for changes to existing stations, such as changes in location, ownership, or reappointment after a suspension. It serves multiple purposes within the inspection station framework.

Misconception 9: Any changes to the inspection station can be made without notifying PennDOT.

This is incorrect. Any change, such as a new owner or a change in authority, must be reported to PennDOT. Failing to do so can invalidate your inspection station's certificate.

Detailed Steps for Filling Out Mv 427 Penndot

Filling out the MV-427 form is an important step when applying for a new inspection station or making changes to an existing one. Ensuring that all required information is provided accurately will help avoid delays in processing your application. Follow these steps to complete the form correctly.

  1. Gather all necessary documents listed in the Safety Station Application Checklist, including proof of insurance, lease, and utility bills.
  2. Use black ink to fill out the MV-427 form, ensuring that you print clearly or type your responses.
  3. In Section A, indicate the reason for your application by checking the appropriate box (e.g., New Inspection Station, Change of Ownership).
  4. In Section B, provide your business name, address, telephone number, owner's name, and driver's license number. If your mailing address differs from your business address, include that as well.
  5. Section C requires additional business information. Specify your ownership type (sole proprietorship, partnership, corporation) and provide your Federal ID and State Sales Tax numbers.
  6. Indicate the size of your inspection area and the type of vehicles you will be inspecting in Section C.
  7. If you own other inspection stations, list their numbers in Section D. If canceling a previous station, provide its name and number.
  8. Complete Section E only if someone other than the owner or corporate officer is responsible for operating the business.
  9. Sign and date Section G, ensuring that the application is signed by the owner or corporate officer.
  10. Review the entire form for accuracy and completeness before submitting it.
  11. Mail or email the completed packet to the Pennsylvania Department of Transportation as indicated in the checklist.

Document Preview

Safety Station Application Check List

Upon submission of the station information packet, all items below must be included. If information is incomplete, the packet will be rejected. A letter will be sent to the applicant, notifying them of the deficiency. Additionally, included in the packet is an instruction sheet detailing how to complete form MV-427.

MV-427 (If applying for a safety and emission inspection, station must complete one form for safety and a separate form for emission. (Do NOT check both safety and emissions on the same form. One form should only specify SAFETY and the other form, if necessary, should only specify EMISSIONS).

MV-427A (must complete two separate forms if applying for a safety and emission inspection station).

MV-443 list of certified safety inspectors (include inspector number).

If you have completed section E Letter of Authority on form MV-427 and the person listed in section E is not listed on the form MV-427 as owner or is not listed as an owner/corporate officer on form MV-427A, you must include a separate document to provide that person’s name and driver’s license number with the packet. (If you are providing an out-of-state driver’s license number, you must also provide date-of-birth with the information.)

MV-500

Certificate of liability insurance or bond: Attach proof of insurance or a bond, in the amount

of at least $10,000.00, providing compensation for any damage to a vehicle during an inspection. A

“ Garage Keeper’s Legal Liability Policy” is acceptable. This proof of insurance or bond MUST include station name, physical location, and amount of coverage and period of coverage.

Must have a valid insurance policy with PennDOT listed as the Certificate Holder, using the address below

Copy of lease or deed

Copies of utility bills (most recent electric and phone bill)

Photos of the interior and exterior of the inspection area, sticker security area, and office area.

Must have a valid Employer Identification Number (EIN) or Social Security Number (SSN)

Must have a valid State Sales Tax Number

The completed packet should be mailed/emailed to:

Pennsylvania Department of Transportation

Vehicle Inspection Division

P O Box 68696

Harrisburg, PA 17106-9003

ATTN: Troy Roadcap, Manager

EMAIL: stationappointments@pa.gov

MV- 4 2 7

I NSPECTI ON STATI ON APPLI CATI ON

I NSTRUCTI ONS

USE: This application should be completed when applying for a new inspection station, and when any changes occur to an existing station, such as; change of location, change of ownership, and reappointment after a suspension, etc.

COMPLETI ON OF FORM: When properly completed and approved, this application will serve as your appointment certificate. Please use black ink and print clearly or type. PROVI DI NG FALSE, I NACCURATE, OR I NCOMPLETE I NFORMATI ON WI THI N THE APPLI CATI ON AUTOMATI CALLY I NVALI DATES THI S CERTI FI CATE.

Section A: I ndicate the reason for this application.

New inspection station: A business which is not currently an inspection station.

Reappoint After Cancel: A previously cancelled station reopens. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) NOT APPLI CABLE FOR PREVI OUS ENHANCED EMI SSI ON STATI ONS.

Reappointment after Suspension: A business that had its inspection privileges suspended and wishes to reopen as an inspection station after the suspension has been served.

Change of Location: An existing inspection station that is moving to a new location or is remodeling the existing location to provide additional space.

Change of Ownership: When a new owner(s) takes over an existing inspection station or when a corporation changes President and the person was never listed as a Corporate Officer in the past. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” )

Change of Authority: When a person in charge of an inspection station changes, but the ownership of the company remains the same. ( Section E should be completed at this time.)

Change of Mailing Address: When a business wants to update an existing mailing address that is different than the physical location.

Add Mailing Address: When a business wants its mail to be delivered to an address other than the physical location of the garage. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Delete Mailing Address: when a business wants to delete an existing mailing address other than its physical location. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Change of address by Post Office: When the business address of the station is being changed by the United States Post Office, or other agency.

Company to Corporation: A sole proprietorship or partnership incorporates. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Change of Trade Name: An existing inspection station making a name change only. (See Company to Corporation above it the station is incorporating) .

Adding or changing a station type: When a general station adds motorcycle, a fleet station changes to a general station and vice versa. (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Add or Drop Partner: When a business adds or drops a partner(s) . (WRI TE THI S REASON I N THE BLOCK MARKED “ OTHER” ) .

Section B: Complete this section with the following information.

Business name: I ndicate the name under which you will operate. (list both names is you trade under a

different name; ie. Smith’s Garage, inc. T/ A Mike Smith Automotive.

Business address: I ndicate the actual location of the business. Must be a street address, no post office boxes in this space. I f you want to use a PO Box, complete the mailing address box in this section.

Telephone number: Provide the business telephone number including area code.

• Ow ner’s name: List the owner of the business. I f business is a partnership list on partner. I f the business is a corporation, list a corporate officer. A regional or district manager is also acceptable.

Driver License# : Provide the owner’s driver’s license number. I f license is issued from a state other than

Pennsylvania, please list the correct state abbreviation after the operator number: e.g., 123038483949 NJ (for operator number from New Jersey) .

Mailing address ( if different from the business address) : May be indicated in the space provided. I f you wish to receive mail from the Department at your business address, the mailing address segment of Section B should remain blank.

Section C: This section provides additional information about your business.

I ndicate if you are the sole proprietor, a partnership, or a corporation. (Commonwealth stations should check corporation) .

I ndicate your Federal I D number and Sate Sales Tax number in the appropriate boxes. I f you have submitted applications to these agencies and have not received your identification numbers, you may write “ APPLI ED FOR” in the appropriate boxes, and then submit your number(s) to the Department when they are received.

I ndicate the size of the I nspection area where inspection are performed (ie. 22ft x 28 ft or if more than one bay, e.g., Bay 1 22ft x 28 ft Bay 2 22ft X 62 ft, etc.)

I ndicate the one category most appropriate for your business.

I ndicate the type(s) of station you wish to operate which should coincide with the type(s) of vehicles you will be inspecting. I f applying for a safety station and an emission station you must complete a separate application for each type. (Do not mark safety and emission on the same application) .

I ndicate the type(s) of station you wish to operate and check the appropriate box(es) for any type(s) of vehicles you will be inspecting at your business.

Section D: First section should be completed when you own another inspection station. Second section should be completed when you need to cancel a previous inspection station.

First Section – Provide the station number(s) of other station(s) you own.

Second Section – Provide the current station number and/ or name of station being cancelled due to change of location, change of ownership or change of station type, ie. Fleet to General.

Section E: This section should be completed by the owner or a corporate officer ONLY when a person OTHER THAN an owner or a corporate officer is responsible for operating the business in the owner/ corporate officer’s behalf.

I MPORTANT: PRI NT ALL PARTS OF SECTI ON E, EXCEPT for the signature of the owner/ corporate officer.

Section F: DO NOT WRI TE I N THI S SPACE.

Section G: The application must be signed by the owner/ corporate officer at the time of application submission. I N THOSE CASES WHERE SECTI ON E HAS BEEN COMPLETED, THE PERSON AUTHORI ZED BY THE OWNER/ CORPORATE OFFI CER MUST SI GN THE APPLI CATI ON.

 

MV-427 (2-08)

 

 

 

 

 

 

 

INSPECTION STATION

 

 

FORDEPARTMENTUSEONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLEASE TYPE OR PRINT CLEARLY.

 

 

 

CERTIFICATE OF

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INCIDENT# ____________________________

 

THIS APPLICATION WILL SERVE AS

 

 

 

 

APPOINTMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR CERTIFICATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

CHECK THE PROPER BLOCK:

 

 

New Inspection Station

 

 

Re-appointment after suspension

 

Change of Location

 

Change ofAuthority within a Company or a Corporation

 

Change of MailingAddress

Change ofAddress by Post Office

 

Change of Trade Name

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

NAME AND ADDRESS OF BUSINESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Business

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business StreetAddress

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

County

 

 

 

 

 

 

 

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone #

 

Owner’s Name

 

 

 

 

 

 

 

 

Driver’s License #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MailingAddress (if different than above)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

County

 

 

 

 

 

 

 

 

State

 

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

BUSINESS INFORMATION

CHECK ✔ OWNERSHIP CLASS:

Sole Proprietorship (A)

Partnership (B) Corporation (C)

 

Federal ID #

 

 

 

 

State Sales Tax #

 

 

 

 

 

Size of InspectionArea

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Category ✔ Check One:

Garage (A)

 

Manufacturer (E)

 

Gas Station (B)

 

New Dealer (C)

 

Used Dealer (D)

 

Station Type: Motorcycle (A)

 

 

 

 

Fleet (C)

 

 

 

 

General (E)

 

Enhanced Safety

 

Commonwealth (F)

 

 

 

 

Emission (X)

 

Trailer (D)

 

 

Inspection (J)

 

Type of vehicles you will be inspecting:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passenger Cars

 

 

Light Trucks

 

Trailers 10,000 lbs or less

 

 

Trucks over 17,000 lbs.

 

Buses

 

 

Motorcycles

 

Trailers over 10,000 lbs.

 

 

Trucks 17,000 lbs. or less

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

Station number of other Station(s) presently owned:

 

 

 

Station number and/or name of current Inspection Station:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

LETTER OF AUTHORITY

 

 

 

F

 

 

 

CERTIFICATION

 

Thisletterauthorizes_______________________________________

 

 

Certificate ofAppointment as an Official Inspection Station

 

 

(Print Name of person signing the application)

 

 

 

 

Pursuant to the provisions of the Vehicle Code, 75 Pa.C.S. Sections 4721,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4723 or 3368,Act of June 17, 1976, No. 81, as amended.

 

________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Title)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

residing at _______________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(home street address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________________

 

 

 

(NOT VALID WITHOUT SEAL)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(city/town)

 

(county)

 

 

 

(state)

(zip)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to be responsible for all inspection operations performed at the above

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

station.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________ _______________

 

 

This certificate may be suspended or cancelled at any time if the provisions

 

 

 

of the Vehicle Code or the inspection regulations are not being complied

 

(Signature of owner or officer)

 

 

 

 

 

 

 

 

(Date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

with or if the business is being improperly conducted.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________

 

 

 

 

 

Any change at a designated Official Inspection Station automatically

 

(Title)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

invalidates this Certificate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G

Application Date:

 

 

 

 

 

 

 

Appointment Date:

 

 

 

 

Inspection

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Station #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Iverifythatthefactssetforthonthisapplicationwerecheckedafterthecompletionoftheformandaretrueandcorrect.Thisverificationismadesubject

 

to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S. § 4904) relating to Unsworn falsification to authorities.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant Signature:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Department Investigator:

 

 

 

 

 

 

 

 

 

 

Troop/Station

 

 

 

 

 

 

Badge #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WHITE - Business Copy

YELLOW - Bureau of Motor Vehicles Copy

PINK - Investigator Copy

MV-427A (4-12)

Station Application

Supplemental Information

For Department Use Only

ATTACHMENT 1

PLEASE TYPE OR PRINT CLEARLY

A.STATION NAME: _____________________________________________________________________________________

B.INSURANCE ACKNOWLEDGEMENT:

I understand that a bond or certificate of insurance in the amount of $10,000 is required for each inspection station. I also understand that failure to maintain this bond or insurance will result in cancellation of my inspection station.

Yes ______ No ______

C.ADDITIONAL INFORMATION:

1.LIST ALL OWNERS, PARTNERS OR CORPORATE OFFICERS (NOTE: Individuals should list thier PA Driverʼs License (PA DL) or Photo ID# in the space provided. Business should list their Business ID# (Bus.ID) where indicated (i.e. E.I.N.)

NAME

TITLE

PA DL/PHOTO ID#

DATE OF BIRTH

 

 

 

 

STREET ADDRESS

CITY

STATE

ZIP

 

 

 

 

NAME

TITLE

PA DL/PHOTO ID#

DATE OF BIRTH

 

 

 

 

STREET ADDRESS

CITY

STATE

ZIP

 

 

 

 

NAME

TITLE

PA DL/PHOTO ID#

DATE OF BIRTH

 

 

 

 

STREET ADDRESS

CITY

STATE

ZIP

 

 

 

 

NAME

TITLE

PA DL/PHOTO ID#

DATE OF BIRTH

 

 

 

 

STREET ADDRESS

CITY

STATE

ZIP

 

 

 

 

2.Has this business or the owners, partners or officers thereof ever been a dealer, miscellaneous motor vehicles business, messenger service, inspection station or issuing agent in this or any other state?

Yes _____ No _____

If yes, list name(s), location(s), and identification number(s).

_________________________________________________________________________________________________

_________________________________________________________________________________________________

3.Is this application for a change of ownership or was this location previously an inspection station?

Yes _____ No _____

If yes, list previous station name(s), address(s) and identification number(s).

_________________________________________________________________________________________________

_________________________________________________________________________________________________

4.Is this inspection station being sold, transferred or leased while the station is suspended or restored pending appeal?

Yes _____ No _____

If yes, were you ever affiliated with this station or are you related in any way to the owner(s)? Yes _____ No _____

5.Have any owners, partners or corporate officers of this business been affiliated with a dealership, miscellaneous motor vehicle business, messenger service, inspection station or issuing agent whose privilege to conduct business as such was suspended, cancelled or revoked or is currently under investigation or received notice to attend a Departmental or court hearing or is awaiting a decision by a hearing officer or a Court?

Yes _____ No _____

If yes, list name, location, and identification number and explain situation.

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

6.Does any owner, partner, corporate officer or any business with which they were previously affiliated, have any outstanding liabilities which are due and owing to the Commonwealth, including but not limited to, taxes, fees, monetary penalties or outstanding paperwork?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

7.Have any owners, partners or corporate officers of this business ever been convicted or administratively sanctioned for violations of Department regulations Chapter 175 or 177 or Chapter 47 of the Vehicle Code?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

8.Have any owners, partners or corporate officers of this business ever remitted uncollectible checks payable to the Department of Transportation or the Commonwealth of Pennsylvania?

Yes _____ No _____

If yes, explain

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

9.Are all owners, partners, officers and management/supervisory employees aware of their responsibilities and obligations relating to the operation of an official inspection station, including but not limited to, record keeping, supervision of employees and customer relations?

Yes _____ No _____

If no, explain

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

I hereby verify that the information set forth above is true and correct to the best of my knowledge, information and belief. This verification is made subject to the penalties of 18 PA. C.C.§4904, relating to unsworn falsification of authorities.

Signature: _________________________________________________________________________________________

Print Name as it Appears Above: _______________________________________________________________________

Title: ________________________________________________________________________________________________

Date: _______________________________________________________________________________________________

MV-443 (3-06)

Commonwealth of Pennsylvania

DEPARTMENT OF TRANSPORTATION

OFFICIAL INSPECTION STATION NUMBER _____________________________

CURRENT LIST OF CERTIFIED

SAFETY INSPECTION MECHANICS

 

OPERATOR’S

MECHANIC

 

NAME

LICENSE

CERTIFICATION

CLASS

 

 

 

EXPIRATION

EXPIRATION

 

 

DATE

DATE

 

1.____________________________________________________________________________________

2.____________________________________________________________________________________

3.____________________________________________________________________________________

4.____________________________________________________________________________________

5.____________________________________________________________________________________

6.____________________________________________________________________________________

7.____________________________________________________________________________________

8.____________________________________________________________________________________

9.____________________________________________________________________________________

10.___________________________________________________________________________________

11.___________________________________________________________________________________

12.___________________________________________________________________________________

13.___________________________________________________________________________________

14.___________________________________________________________________________________

15.___________________________________________________________________________________

16.___________________________________________________________________________________

17.___________________________________________________________________________________

MV-500 (11-10)

www.dot.state.pa.us

Bureau of Motor Vehicles

Vehicle Inspection Division

P.O. 68697 • Harrisburg, PA 17106-8697

Pennsylvania Department of Transportation Authorized Agents for Purchasing Stickers

r NEW

r REVISED (PLEASE CHECK ONE)

 

PRINT NAME AS LISTED ON ID

 

OPERATOR NUMBER

 

SOCIAL SECURITY#

 

OR DRIVER’S LICENSE

 

 

 

(IF NON-PA DRIVER’S LICENSE)

 

 

 

 

 

1.

_____________________________

1.

_____________________________

1.

_____________________________

2.

_____________________________

2.

_____________________________

2.

_____________________________

3.

_____________________________

3.

_____________________________

3.

_____________________________

4.

_____________________________

4.

_____________________________

4.

_____________________________

5.

_____________________________

5.

_____________________________

5.

_____________________________

I hereby authorize the above listed person(s) to sign sticker requisitions and receive Certificates of Inspection for the following Official Inspection Station:

__________________

__________________________________

________________________

(Station Number)

(Station Name)

 

(Telephone #)

______________________________________________________________

____________________

(Signature of Station Owner or Authority) - Station Owner or Authority must be listed in one of the five lines above.

(Title)

______________________________________________________________

____________________

(Print Name As It Appears Above)

 

 

(Date)

REVIEW INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING.

THIS FORM MAY NOT BE COPIED OR FAXED

Official Inspection Stations must use this form to authorize purchaser(s) to sign Form MV-436A, "Inspection Sticker and Insert Order Form."

You may submit up to five names to be placed in a computerized signature file for your station. (NO MORE THAN FIVE (5) NAMES ARE PERMITTED). Each name submitted must include, driver’s license number (or government issued photo identification card number) and Social Security number (if non-PA driver’s license).

If the station owner or authority (as listed in sections B or E of the certificate of appointment Form MV-427) or corporate officer, partner, etc. (listed on Form MV-427A) intends to sign Form MV-436A to purchase inspection stickers, his/her name, operator number, and Social Security Number

(if applicable) must also be listed on one of the five (5) designated spaces.

If the REVISED box is checked, you will need to list all persons whom you have previously authorized and wish to remain authorized. Any names that are not on this form will be deleted from the computerized signature file.

Stations which are appointed to perform both safety and emission inspections may submit only one (1) authorization form. The authorized purchasers for these stations will be able to sign Form MV-436A for both safety and emission stickers.

Bonded messengers and members of the Legislature cannot be listed on this form as authorized purchasers.

Return this form to: Bureau of Motor Vehicles, Vehicle Inspection Division, P.O. Box 68697, Harrisburg, PA 17106-8697. If you have questions please call (717) 787-2895.

Dos and Don'ts

When filling out the MV-427 PennDOT form, it is essential to follow specific guidelines to ensure your application is accepted. Below are four things you should do and four things you should avoid.

  • Do use black ink and print clearly. This helps prevent any misunderstandings or misinterpretations of your information.
  • Do complete separate forms for safety and emissions inspections. Each type of inspection requires its own application to avoid confusion.
  • Do include all required documentation. This includes proof of insurance, a list of certified inspectors, and any necessary letters of authority.
  • Do provide accurate information. Ensure that all details, such as names and addresses, are correct to avoid delays or rejections.
  • Don't check both safety and emissions on the same form. This will lead to an automatic rejection of your application.
  • Don't leave any sections blank. Incomplete forms will result in a notification of deficiency, which can delay the process.
  • Don't submit outdated or incorrect documents. Ensure all attachments are current and relevant to your application.
  • Don't forget to sign the application. An unsigned application will be deemed invalid and will not be processed.

Key takeaways

1. Complete All Required Forms: Ensure you fill out the MV-427 and MV-427A forms completely. If applying for both safety and emissions inspections, submit separate forms for each. Do not check both options on a single form.

2. Include Necessary Documentation: Your application packet must include several key documents, such as proof of liability insurance, a copy of your lease or deed, and utility bills. Missing items will lead to rejection.

3. Provide Accurate Information: Fill out the forms using black ink and print clearly. Any false or incomplete information will invalidate your application. Double-check all entries before submission.

4. Understand the Application Process: The MV-427 form is used for new inspection stations and for changes to existing stations. Familiarize yourself with the different sections to ensure you provide all necessary details.

5. Submit Your Application Correctly: Send your completed application packet to the Pennsylvania Department of Transportation, Vehicle Inspection Division. Ensure it is addressed correctly to avoid delays.

Similar forms

The MV-427 form is similar to the MV-427A form, which serves as a supplemental application for inspection stations. Both forms are essential when applying for an inspection station, particularly when a business intends to operate as both a safety and an emissions inspection station. The MV-427A requires additional details about the owners, partners, or corporate officers involved in the business. It emphasizes the need for separate submissions for safety and emissions inspections, ensuring clarity and compliance with regulations. This distinction helps streamline the application process and maintain organized records for the Pennsylvania Department of Transportation.

Another document comparable to the MV-427 is the MV-443, which lists certified safety inspectors. This form is critical because it provides the Pennsylvania Department of Transportation with a record of individuals authorized to perform inspections at the station. Just as the MV-427 requires detailed information about the station itself, the MV-443 focuses on the qualifications and certifications of the inspectors. By ensuring that only certified individuals conduct inspections, the MV-443 contributes to the overall safety and reliability of the inspection process.

The MV-500 form also bears similarities to the MV-427, as it pertains to the insurance requirements for inspection stations. Just like the MV-427 mandates proof of insurance or a bond, the MV-500 outlines the necessary coverage details, including the amount and duration of the policy. This form serves to protect both the inspection station and the vehicles being inspected, ensuring that there is adequate financial backing in case of any damages. By requiring documentation of insurance, the MV-500 reinforces the accountability of inspection stations in Pennsylvania.

Lastly, the Certificate of Liability Insurance or Bond is another document that parallels the MV-427. This certificate is crucial for demonstrating that the inspection station has the necessary financial protections in place. Similar to the MV-427's requirement for proof of insurance, this document must specify the station's name, physical location, and coverage amount. The inclusion of this certificate in the application packet ensures that the station meets state regulations and can operate without exposing itself or its clients to undue risk. Both documents work together to establish a safe and compliant environment for vehicle inspections.

Documents used along the form

When applying for an inspection station through the MV-427 form, several other documents are often required to ensure a complete and compliant application. Each of these documents serves a specific purpose and helps to verify the legitimacy and readiness of the inspection station. Below is a list of commonly used forms and documents that accompany the MV-427 form.

  • MV-427A: This form is necessary when applying for both safety and emissions inspections. Applicants must submit two separate MV-427A forms, one for each type of inspection, ensuring that both applications are clearly defined.
  • MV-443: This document includes a list of certified safety inspectors associated with the inspection station. It is crucial to provide the inspector numbers to confirm that the personnel are qualified to conduct inspections.
  • Letter of Authority: If a person listed in section E of the MV-427 is not the owner or a corporate officer, a separate document must be submitted. This document should include the name and driver’s license number of that person, ensuring proper identification and authority.
  • MV-500: This form may be required for certain applications, providing additional information or compliance details relevant to the inspection station's operations.
  • Certificate of Liability Insurance or Bond: Proof of insurance or a bond is mandatory, with a minimum coverage of $10,000. This document protects against damages during inspections and must list the station's name, location, and coverage details.
  • Utility Bills: Recent copies of utility bills, such as electric and phone bills, are needed to verify the operational status and physical location of the inspection station.

These documents collectively support the application process, ensuring that all necessary information is available for review. Submitting a complete packet helps avoid delays and increases the likelihood of a successful application for the inspection station.