Form Vr-028 Application For Salvage Certificate/owner Retention
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2Motor Vehicle Administration
VR-028 (02-16)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Application for a Salvage Certificate/Owner Retention
This application must be accompanied by a copy of the valid state issued identification(s) of the applicant(s) and any person presenting the application.
This application is to be used by the vehicle owner, when a vehicle is sold as salvage pursuant to
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Certificate # (MVA Use Only)
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§13-506 and §13-507 or acquired as an abandoned vehicle from a police auction pursuant to
Salvage Certificate
§25-207 of the Maryland Vehicle Law.
For reference refer to back of this form.
Maryland Vehicle Law §13-506.1 requires the insurance company to promptly notify the Motor Vehicle Administration of vehicles that
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have been settled as a salvage and are being retained by the owner.
Owner Retention
If the applicant checks boxes 1 or 6, a Corrected Certificate of Title bearing the appropriate brand will be issued. The fee will be $40.00.
If the applicant checks box 3, a Salvage Certificate bearing the appropriate brand will be issued. The fee will be $20.00.
NOTE: Boxes 2, 4, 5, 8 and 9 are not applicable for owner retention.
Applicant’s Full Name
Date of Birth
FEIN #
Driver’s License Number
Co-Applicant’s Full Name
Date of Birth
Driver’s License Number
Street Address
City or Town
State
Zip Code
Description of Salvage Vehicle:
Model
Year
Make
Body Style
Vehicle Identification Number
Gross Vehicle Weight
Out of State Title #
Maryland Title #
Applicant Is:
For:
Reason For Duplicate:
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Certificate of Origin?
Yes
No
Purchase Price $ ___________________
Title Service # ______________________
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Insurance Company
Lost
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Original
Odometer Reading ________________________ (No Tenths)
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Vehicle Owner
Stolen
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1. The mileage stated is in excess of its mechanical limits.
Dealer # ___________________________
Scrap Processor # __________________
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Duplicate
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Automotive Dismantler & Recycler
Mutilated
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2. The odometer reading is not the actual mileage.
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Scrap Processor
Other
Auctioneer # _______________________
AD&R # ____________________________
Warning - Odometer Discrepancy
FOR INSURANCE COMPANY USE ONLY
To be completed by applicant:
Date of Accident
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1. Damage is greater than 75% of the fair market value and repairable.
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2. Damage is 75% or less of fair market value.
Were the tag(s) destroyed as a result of the accident?
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3. The vehicle is not rebuildable, will only be used for parts, and is not to be retitled.
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Tag No. _________________________
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Yes
No
4. Abandoned vehicle or acquired in the normal business of an Automotive Dismantler & Recycler.
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5. Recovered Stolen with damage 75% or less of the fair market value will be issued a Salvage Certificate branded “Recovered Stolen”.
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6. Flood damage
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7. Recovered Stolen with damage 75% or less than the fair market value and requesting a Certificate of Title - Complete an Application for Certificate of Title (VR-005).
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8. Stolen
I certify under penalty of perjury, that the statements herein are true and correct to the best of my knowledge, information and belief.
Signature of Applicant(s) or Authorized Agent: ___________________________________________________________________________________
Date: _______________________________________________________________________________
If a company, must be signed by an authorized agent (capacity)
Printed Name of Applicant(s): ___________________________________________________________________________________________________
Date: _______________________________________________________________________________
Business Name: _____________________________________________________________________ FEIN # ___________________________________
Date: _________________________________________________________________________
For more information, please call: 410-768-7000 (to speak with a customer agent).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at:
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