Form Mv-908 - Salvage Vehicle Waiver
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1SALVAGE VEHICLE WAIVER
WAIVER PURSUANT TO NEW YORK STATE VEHICLE AND TRAFFIC LAW § 430(2).
VEHICLE
Year: _______________
Make: ___________________________
Model: ______________________________
VIN: ___________________________________________________
Recovered by (Law Enforcement Agency): _____________________________________________________________
Insurance Claim Number:__________________________
Vehicle’s Value at Date of Loss: $ __________________
ATTESTATION
I,
_________________________________________________________, ___________________________________
(Name)
(Title)
for the________________________________________________________________________ Insurance Company
_______________________________________________________________________________ attest as follows:
(Address)
1. No major component part of the motor vehicle has been replaced since the theft of such vehicle, and
2. Repairs made to the vehicle since the recovery of such vehicle have not exceeded one-fourth of the amount paid by
the insurance company in settlement of the claim or have not exceeded one thousand dollars, and
3. The vehicle identification number and all other manufacturers’ identifying numbers on the motor vehicle have been
examined by the insurance company and are intact in the same form as at the time of theft of such vehicle.
The vehicle (if applicable) sustained damage in the amount of $ _______________.
In support of this affidavit I have enclosed an appraisal or estimate of repairs.
ç
NOTARY PUBLIC:
(Signature)
Sworn before me on this ______ day of
__________________, in the year of ______
(
)
(Phone #)
(Notary Public)
[Seal]
(E-Mail Address)
RESET/CLEAR
MV-908 (12/15)
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