Form Mvr-4f - Affidavit And Notification To Owner Page 2
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1
2Back MVR-4F
(Rev.11/13)
PURPOSE
This form is to be used by an NC insurance company when a salvage vehicle owner fails to assign and deliver the vehicle's certificate of
title to the insurer within 30 days of the payment of the claim in accordance with North Carolina General Statute 20-109(b)(1). This
form may also be used by a North Carolina car dealer, whose primary business whose is the sale of salvage vehicles on behalf of insurers
and taking possession of salvage vehicles that are the subject of insurance claims, where an owner or lienholder abandons the vehicle.
INSTRUCTIONS FOR THE INSURANCE COMPANY
Insurer must send certified request for title at least 30 days prior to submitting request from the Division and provide proof of delivery.
Insurer must provide proof of payment of the claim. Insurer must provide evidence that funds were paid to the first lienholder shown on
the Division's record. Insurer must complete all application sections of the form including odometer and damage disclosure certification.
Upon receipt of form MVR-4F, supporting documents and a fee of $15.00 the Division will issue the insurer an MVR-40 (salvage
certificate) to be used to sell the vehicle.
INSTRUCTIONS FOR THE NC DEALER
Dealer must be licensed in North Carolina and operate a business in accordance with North Carolina General Statutes 20-109(e1). Dealer
must have authorization from the insurance company to release the vehicle to the owner or lienholder. Dealer must have possession of
vehicle for 30 days. Dealer must send notification via certified mail to the lienholder or owner informing them that the vehicle is
available for pickup. Notice shall include outstanding charges owed to the motor vehicle dealer. Dealer must provide proof of delivery of
notice. Dealer may submit request for title by submitting MVR-4F if the vehicle is not picked up within 30 days. Dealer must complete all
applicable sections of the form including odometer and damage disclosure certification. Upon receipt of form MVR-4F, supporting
documents and a fee of $15.00, the Division will issue the Dealer a MVR-40 (salvage certificate) to be used to sell the vehicle.
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