The procedure for getting a Title and Registration changed about a year and a half ago. Unfortunately no one at the DMV knew what it was before and they still don't. Step 1. You need to go to a "full service" DMV office. That means Reno or Vegas. Step 2. Go to the actual DMV Vehicle Inspection station and get the forms you need. It is NOT the standard inspection form, It's called a VP-17, and it has multiple sections. I do have the instruction part of the form , I'll scan it and add it later. The top section requires you take the truck to a registered garage or licensed repair shop to have it inspected. I had already left Carson City, headed to Reno, and stopped at a Diesel place, but they wouldn't do it. A Ford dealership did it for 190$ but I had to talk them into it. [Everyone gets hung up on the VIN not being 17 digits] The inspection is pretty basic, lights, horn etc. Then to the DMV, where the vehicle inspection guys want to make sure it is street legal. They ask probing questions like "Are there any stickers that say "Off Road Use Only?" Then next door to the emissions lab, where they ask about the weight, [on the SF-97] and basically exempt the weight, odometer, and emissions. With your new impressive stack of paperwork, you can now go to your actual DMV appointment. They'll still be befuddled, but after a couple of employees and 2 supervisors I got it done. Oh...make sure you have a printout from GovPlanet that shows you paid sales tax. I had to look it up on my phone, take a screenshot, and email it to the DMV gal sitting in front of me. Took me all day because my appt was in Carson City, but I had to go to Reno, then back to Carson to do the rest. This boring post is just for searchable future reference, but I did get the plate I wanted... 
