Form T-22r - Request For An Inspection Of A Rebuilt Motor Vehicle
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1T-22R (Revised 07-2005)
Request for an Inspection of a Rebuilt Motor Vehicle
Attn: Salvage Unit
Dept. of Revenue/Motor Vehicle Division
PO Box 740384
ATLANTA, GA 30374-0384
This is to request that the rebuilt vehicle described below be inspected. If this vehicle is eligible for a Georgia
title and it passes your inspection, please authorize the issuance of a certificate of title.
Vehicle Information
Year & Make of Vehicle
Vehicle Identification Number
Owner Information
Georgia Tax Numbers
Vehicle Owner(s)’ Name(s)
Sales Tax #
Street Address
Withholding Tax #
Telephone Numbers
City, State & Zip
Home Telephone # Including Area Code
Vehicle Location
Vehicle Location (Residence or Business Name)
Work Telephone # Including Area Code
Street Address
Contact Person
Person’s Name to Contact Regarding Inspection
City, State & Zip
I understand that it is my responsibility, as the applicant, to have the vehicle available
for
inspection
during regular business hours, 8:00 a.m. to 4:45 p.m. Monday through Friday,
excluding state holidays, unless otherwise instructed by an MVD Inspector. I also understand
that a $100 inspection fee must be paid to the Department of Revenue each time the vehicle
is inspected. I have listed two (2) telephone numbers where I, or someone else who is familiar
with the vehicle, can be reached in order to schedule an appointment to have the vehicle
inspected. If the Inspector is unable to reach me or my contact person by telephone at the
telephone numbers listed above, MVD will place all received documents in file and will mail
a letter to me at my home address shown above requesting that I contact the Inspection Unit
of the Motor Vehicle Division to schedule an appointment to have the vehicle inspected.
Owner’s Signature
Owner’s Signature:
Date:
For Department’s Use Only
Salvage Clerk’s Signature
Date:
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