Form Mv-6 - Application For Nonrepairable Or Salvage Certificate

Download a blank fillable Form Mv-6 - Application For Nonrepairable Or Salvage Certificate in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Mv-6 - Application For Nonrepairable Or Salvage Certificate with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

MV-6 (12-15)
APPLICATION FOR NONREPAIRABLE
OR SALVAGE CERTIFICATE
For Department Use Only
See Instructions on Reverse
Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104
check (4) Proper Block
q
q
q
1.
Original Certificate of Salvage
2.
Duplicate Certificate of Salvage
3.
Original Nonrepairable Certificate
q
check here
if vehicle is a total loss due to flood (salvage certificate will be branded with a “W”).
q
check here
if vehicle is a total loss due to theft (salvage certificate will be branded with a “N”). NOTE: Section e must be completed if no police incident
report is attached.
A
APPLICANT INFORMATION
PA DL/Photo ID#
Date of Birth
Last Name (or Full Business Name)
First Name
Middle Name
or Bus. ID#
Date of Birth
PA DL/Photo ID#
co-owner Last Name
First Name
Middle Name
Street Address
State
Zip code
city
B
VEHICLE DESCRIPTION
title Number
Vehicle Identification Number
Year
Make
owner’s Name as Printed on Face of Attached title
NO TENTHS
I/We certify to the best of my/our knowledge that the odometer reading is ____ ____ ____ , ____ ____ ____
miles and reflects the actual mileage of the vehicle,
unless one of the following boxes is checked:
is NOT the actual mileage. WARNING: odometer discrepancy
reflects the amount of mileage in excess of mechanical limits
WARNING: Federal and state laws require that you state the mileage in connection with this application. failure to complete or providing a false statement may result in fines
and or imprisonment.
C
VEHICLE IDENTIFICATION NUMBER VERIFICATION
NOTE: If an out-of-state certificate of title is attached to this application, a tracing of the Vehicle Identification Number (VIN) must be affixed in the space
provided. If a tracing cannot be obtained, the VIN must be listed and verified by a certified inspection mechanic or authorized agent in the
appropriate spaces below.
List VIN or tape
VIN tracing Here
Authorized Agent or certified Inspection Mechanic (Print Name)
DIN/Mechanic #
Authorized Agent or certified Inspection Mechanic Sign Here
I certify that a legible tracing cannot be secured and that the
above VIN listed in Section c is correct
D
APPLICATION FOR DUPLICATE
REASON:
Lost
Stolen
Defaced (certificate must be attached)
Never recieved
*other
* Please Explain: __________________________________________________________________________________________________________
LAW ENFORCEMENT REPORTING - to be completed by the applicant when applying for an original certificate of salvage and no police
E
report is attached.
check (4) one: REPORTED TO:
Local Law enforcement
State Law enforcement
Incident Number
Date of Incident
Law enforcement Station Name
Law enforcement telephone Number
Law enforcement Station Address
Nature of Incident
Investigator
Badge Number
F
SIGNATURES
I/We certify that all information provided on this form is true and correct.
______________________________________________________________________________________________
_________________________________________
Signature of Applicant or Authorized Person
telephone Number
______________________________________________________________________________________________
_________________________________________
Signature of co-Applicant
Date

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2