Form Mv-83sal - Salvage Examination/title Application - 2017
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2SALVAGE EXAMINATION/TITLE APPLICATION
For more information on salvage,
visit dmv.ny.gov
o
o
o
I AM APPLYING FOR:
A. Salvage Exam & Title
B. Salvage Exam Only
C. Salvage Exam Reapplication
Your current proof of ownership determines the total fee you must pay. Make your check or money order payable to “Commissioner of Motor Vehicles”.
A.
l
New York State Salvage Certificate (MV-907A):
$200.00
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New York State title/Out-of-state title/Marshall’s sale/Police Bill of Sale/Garageman Lien:
$205.00
B. If your vehicle is already registered in NY (Plate Number: ______________________) and you were notified it needed an exam:
$155.00
Case number on letter you received: __________________________________________
C. Salvage exam reapplication fee due to a missed appointment:
$150
NOTE: These fees cannot be refunded. No third party or starter checks will be accepted.
NAME OF PRIMARY OWNER (Last, First, Middle)
NYS driver license number of PRIMARY
SEX
DATE OF BIRTH
Month
Day
Year
M F
o o
NAME OF CO-OWNER (Last, First, Middle)
NYS driver license number of CO-OWNER
SEX
DATE OF BIRTH
Month
Day
Year
M F
o o
CONTACT TELEPHONE # (Required)
Is this a corporation or partnership?
Area Code
o
o
Yes
No
(
)
THE ADDRESS WHERE PRIMARY OWNER GETS MAIL
(Include Street Number and Name, Rural Delivery or box number. This address will be on the document.)
Apt. No.
City or Town
State
Zip Code
County of Residence
THE ADDRESS WHERE PRIMARY OWNER RESIDES IF DIFFERENT FROM THE MAILING ADDRESS
(DO NOT GIVE A P.O. BOX.)
.
Apt. No.
City or Town
State
Zip Code
VEHICLE IDENTIFICATION NUMBER
VEHICLE DESCRIPTION
Year
Make
Body Type For Cars (mark one)
Body Type For Other Vehicles (mark one)
Color
Unladen Weight
Station Wagon or
o
o
o
o
o
Pick-up
Tow
2-Door
4-Door
Convertible
Suburban
Other______________
o
o
o
o
o
o
Van
Motorcycle
Trailer
Other _______________
Truck
Truck
Type of Power (Fuel)
For trailers & commercial vehicles
For rentals,buses & taxis
For commercial vehicles
o
o
o
o
Cylinders
Maximum Gross Weight
Seating Capacity
Axles
Distance
Gas
Diesel
Electric
Flex
o
o
o
o
CNG
Propane
Hybrid
None
Odometer Disclosure/Reading in Miles
o
o
o
I certify that the odometer reading of ____________________________________________________________________________ is
Actual,
Not Actual, or
Exceeds mechanical limits.
NY
Lien Filing Code
Lien holder Name and
DEALER
(Assigned
Mailing Address
by DMV)
ONLY
(If you want the examination notice sent to another address, or by email, please complete the following):
EMAIL AND ALTERNATE ADDRESS
Name (Use Corporate
Name, if applicable)
Address (Number
Apt. #
and Street)
City
State
ZIP Code
É
E-mail Address
Home Telephone No.
Business Telephone No.
(Please print clearly)
(
)
(
)
É
Email Notification: If you have provided your email address, the email notice you receive will be the only notification sent to you. Please save and print that notice as
you will NOT receive a letter by regular mail.
I request that the vehicle be examined at the following location:
APPOINTMENT SITES:
__ Buffalo
__ Syracuse
__ Utica
__ Albany
__ Elmsford (serves Putnam/Westchester/Rockland & Bronx counties)
__ Rochester
__ Binghamton*
__ Canton*
__ Plattsburgh*
__ Queens Village (serves New York/Queens/Kings & Richmond counties)
__ Horseheads*
__ Highland
__ Oxford*
__ West Babylon (serves Nassau & Suffolk counties)
Only occasional service is offered at this location.
*NOTE:
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o
Do you need a permit to drive the vehicle to/from the exam location (NYS residents only)
Yes
No
If yes, please include:
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current proof of NYS insurance (a copy of form FS-20 or form FS-21)
NYS Safety/emissions Inspection report showing “passed”
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If you do not provide a completed application, the proper forms, fees and signatures,
your application and check or money order will be returned to you.
MV-83SAL (8/17)
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