Form Mv-1sp - Cancellation Of Certificate Of Title For Scrap/derelict Vehicles
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MV-1SP (7/2012)
Cancellation of Certificate of Title for Scrap/Derelict Vehicles
Vehicle Description
Vehicle Identification Number
Year
Make
Model
Color
Owner Section
First
Middle
Last
Driver’s License # & State
Street Address
City
State
Z
I certify:
There are no security interests or liens on this vehicle
o
I have not obtained a Certificate of Title on this vehicle or have lost the Certificate of Title
o
This vehicle is 12 model years or older
o
For a motor vehicle, this vehicle is worth less than $850.00
o
For a trailer, this vehicle is worth less than $1,700.00
o
This vehicle will be dismantled or scrapped and never be titled again
o
I swear that I am the owner of this vehicle and I acknowledge that this form will be filed with the Department of Revenue
and it is a felony, punishable by imprisonment for not fewer than one nor more than three years or a fine of not less than
$1,000.00 nor more than $5,000.00 or both to knowingly falsify any information on this statement.
_____________
_____________
_____________
_____________
_______________________________________
Printed Name (Must be legible)
Signature
____________________________________________________________ ______________________________
If applicable, Name of Business
Date
Licensed Used Motor Vehicle Parts Dealer, Secondary Metal Recycler
or Scrap Metal Processor Section
Name of Business and National Motor Vehicle Title Information System (NMVTIS) Identification Number
NMVTIS number:
Street Address
City
State
Z
Business Phone #
I certify
This motor vehicle was acquired for $850.00 or less, or this trailer was acquired for $1,700.00 or less, and
o
I have verified this vehicle is not currently subject to any security interest or lien
o
___________________________
___________________________
___________________________
_____
_____
_
_________
Printed Name of Person (Must be legible)
Signature
_______________________________________________________ ___________________________________
Title
Date
Within 72 hours, this form must be mailed or delivered to:
Georgia Department of Revenue
Motor Vehicle Division
P O Box 740381
Atlanta GA 30374-0381
All previous revisions of this form are obsolete. This form must be printed or typed legibly. Any error or corrections will
void this form. A copy of this form must be provided to the owner or agent for the owner and retained by the purchaser.
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Parent category: Financial