Not what its name suggests, and that is the reason it has a page here. 'Statement of Fact' sounds like a general-purpose letter to the Bureau of Title, and sellers search for it as though it were one. It is not: every line of it certifies that a specific vehicle has been converted and equipped for use on a public way as required in Saf-C 1904.02 - an off-highway machine or a motorcycle made street legal - and it is signed by the owner and a mechanic together.
Written against TDMV 114 (3/22), issued under Saf-C 1904.02 and RSA 215-A:35 to 39.
If you are selling a side-by-side, a dirt bike or a converted off-highway vehicle in New Hampshire, this is the document a buyer will want to see before they try to register it - and if you are selling an ordinary car, this form has nothing to do with you no matter how much its name sounds like it might.
Two documents, and they are not the same thing. Take the blank TDMV 114 from the dmv.nh.gov copy so you get the revision that is current today, then print our TDMV 114 guide and keep it beside you while you fill theirs in.
This is the actual TDMV 114, rendered from the PDF the New Hampshire Division of Motor Vehicles publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
Read the line under the heading before anything else. This form is about a vehicle that was never built for the road - the name at the top is generic and the content is not, which is why sellers of ordinary cars keep finding it and it never helps them.
Field by field
Every line, in the order you meet it
1
You fill this in
Check this is your form at all
The printed certification names Saf-C 1904.02 and the body of the form cites RSA 215-A:35 to 39.
Watch out: If the vehicle came from a factory with number plates on it, close this form and look at the Voided Assignment Letter or the Affidavit of Ownership instead.
2
You fill this in
Date
The date of the statement.
Watch out: It should sit after the conversion work, not after the sale. The mechanic's signature is about work that has already happened.
3
You fill this in
The identification number
The seventeen cells under the certification line, one character apiece.
Watch out: Off-highway machines carry their number in unexpected places. Find it on the machine rather than on a receipt.
4
You fill this in
Model year, make, model, body style
The description row.
Watch out: Body style on a converted machine is whatever the Division would recognise it as, and a clerk would rather you asked than guessed.
5
You fill this in
Owner name and address
Two lines.
Watch out: The owner at the time of the conversion, which on a sale is still you.
6
You fill this in
The two signatures
Owner, and mechanic or owner, each dated.
Watch out: The second line exists so somebody who worked on the vehicle stands behind the equipment list. A form with the same signature twice is not what the layout is asking for.
At a glance
What goes where
On the form
What to put in it
The certification
Printed across the top: vehicle has been converted and equipped for use on public way as required in SAF-C 1904.02.
Date
Of the statement.
Vehicle
Vehicle identification number in a seventeen-cell comb, then model year, make, model and body style.
Vehicle owner
Name and address.
The equipment list
Head lights; tail lights and brake lights; emissions; safety equipment; exhaust silencer or spark arrestor; mirrors; horn - printed as a list of what may need to be modified, not as tick boxes.
Two dated signature lines
One for the owner and one for the mechanic or owner, each with its own date.
What gets this one rejected
•Using it as a covering letter about something else entirely. The printed certification is about street conversion and nothing else, and a Bureau clerk reads what is printed rather than what was intended.
•One signature where the form prints two lines - owner, and mechanic or owner.
•A vehicle that is not the kind this is for. The statute cited is RSA 215-A, the off-highway recreational vehicles chapter.
Rules that decide whether it is accepted
•What it is actually certifying. That a vehicle although not originally intended for street use has been modified to be legally registered and inspected for use on the public ways of New Hampshire, as defined in RSA 215-A:35 to 39.
•The equipment list is indicative, not exhaustive. The form says 'listed below but not limited to, is a list of equipment that may need to be modified'.
•What a seller should use instead. For a spoiled assignment, the Voided Assignment Letter. For a mileage correction, a signed statement from the person who originally misstated the reading, which the Division says does not need notarising. For an antique with no paperwork, the Affidavit of Ownership. None of those is this form.
Every line here was read off TDMV 114 (3/22) itself — the PDF is here — and off the New Hampshire Division of Motor Vehicles pages.
This is plain-language help with a form, not legal advice, and where our wording and the agency's differ,
theirs governs.
