Dr 2410 - Application For Salvage Title Or Nonrepairable Title Form

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DR 2410 (03/03/15)
State of Colorado
COLORADO DEPARTMENT OF REVENUE
Division Of Motor Vehicles
Application For Salvage Title Or Nonrepairable Title
Title Section
Upon the sale or transfer of a motor vehicle for which a current Colorado certificate of title has been issued or filed and that has
become a salvage vehicle, as defined in section 42-6-102 (17)
, the purchase or transferee shall apply for a Salvage Certificate of Title.
A Salvage Title may not be issued for off-highway vehicles, snowmobiles, or vehicles classified as a collector’s item, horseless carriage,
or street rod vehicle at the time of damage.
A Nonrepairable Title may only be issued to vehicles designated as a source of parts or scrap.
Any Alteration Or Erasure In The Application May Void The Document
Vehicle Identification Number (VIN)
Application for:
Salvage Title
Nonrepairable Title
Year
Make
Body
Model
Dealer
Color
CWT
Fuel Type
Date Purchased
Taxable Value
MSRP
Odometer Reading and Indicator
Legal Name(s) as it Appears on Identification*
Reason for Damage:
and Address of Owner(S) or Entity
Accident/Collision
Fire
Flood
Vandalism (Trespass)
Weather (Excluding Hail, explain below)
Other (explain below)
___________________________________________________________
___________________________________________________________
*Statement of One in the Same is required when the
___________________________________________________________
owner’s name on the Secure and Verifiable ID differs from
the owner’s name on the application/title.
___________________________________________________________
_________________________________________ and
Estimated Repair Cost $ _________________________
__________________________ are one and the same.
I certify, under penalty of perjury in the second degree, that the motor vehicle described above has been damaged in excess of the reasonable
fair market value by an event as listed above, excluding hail damage. The vehicle is now considered salvage and there are no liens
outstanding against this vehicle. I understand that the vehicle cannot be registered until it has been repaired to meet the requirements of a
roadworthy vehicle as defined by C.R.S. 42-6-102 (15) and a Rebuilt from Salvage Certificate of Title has been issued. I also understand that if
a Nonrepairable Title is issued, this vehicle may only be used as a source of parts and may not be registered as a complete vehicle.
Printed name of Owner/Agent as it appears on Identification
Owner or Agent Signature
Date
Secure and Verifiable ID of Owner/Agent:
Colorado DL
Colorado ID
Other _____________________________________________________________
ID #
Expires
DOB
The undersigned witness affirms that the named owner of the vehicle identified in this document presented the identification described above.
Witness Signature
Date
To create joint tenancy with rights of survivorship, there must be specific language declaring such intent, signed under penalty of
perjury in the second degree by all owners. This area is only applicable to multiple owners. If any owner chooses Tenants in
Common or neither box is checked the Colorado Certificate of Title will be issued as Tenancy in Common.
I _____________________________ (print name) request the Colorado Certificate of Title for the Vehicle described above be issued in:
Joint Tenancy With Rights of Survivorship
Tenancy in Common
Per C.R.S. 42-6-116; I certify under penalty of perjury in the second degree that the above information is true and correct to the best of my
knowledge.
Owner’s Signature_________________________________________________________ Date__________________________
I _____________________________ (print name) request the Colorado Certificate of Title for the Vehicle described above be issued in:
Joint Tenancy With Rights of Survivorship
Tenancy in Common
Per C.R.S. 42-6-116; I certify under penalty of perjury in the second degree that the above information is true and correct to the best of my
knowledge.
Owner’s Signature_________________________________________________________ Date__________________________

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