Form Mv-901d - Garagemans Certification And Bill Of Sale For Vehicles Worth

Download a blank fillable Form Mv-901d - Garagemans Certification And Bill Of Sale For Vehicles Worth 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-901d - Garagemans Certification And Bill Of Sale For Vehicles Worth 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.

GARAGEMAN’S CERTIFICATION AND BILL OF SALE FOR

VEHICLES WORTH LESS THAN $500.00

DISPOSAL OF LAWFULLY TOWED AND/OR STORED VEHICLES UNDER LIEN LAW, SECTION 202

(This form is also available to download from the DMV website: )

NOTICE: THE VEHICLE DESCRIBED HEREIN MAY NEVER BE TITLED AGAIN. IT MUST BE DISMANTLED OR SCRAPPED.

AFTER COMPLETION, PLEASE SUBMIT THIS FORM TO THE VEHICLE DISMANTLER OR SCRAP PROCESSOR.

IMPORTANT INFORMATION REGARDING THESE REQUIREMENTS CAN BE FOUND ON FORM MV-901DI.

To knowingly make a false statement or conceal a material fact in this statement is a criminal offense punishable under Section 210.45 of the

Penal Law, and Section 392 of the Vehicle and Traffic Law.

I, the undersigned GARAGEMAN, certify under penalty of perjury as follows (if signing as an authorized representative of a business organization,

such as a corporation, I certify that I possess the personal knowledge to make such certification and I am duly authorized to so certify on behalf of the

business): (1) the undersigned currently holds a valid, perfected Garageman’s Lien on the motor vehicle described herein; (2) such lien represents

accrued and unpaid towing and/or storage charges which remain unpaid to date; (3) the subject vehicle currently has a wholesale value of less than

$500, as indicated by the nationally recognized source checked below; and (4) the undersigned sold this vehicle to the vehicle dismantler or scrap

processor named herein.

Description of Vehicle (a statement of acquisition must be attached [see MV-901DI]):

Year: _______

Make: ________________________ Model: ________________________ Plate Number: ___________________ State: ________

Vehicle Identification Number:

(attach photo or tracing)

____________________________________________

Wholesale Value of Vehicle: $ _________________________

Source of Wholesale Value

NADA

Kelly Blue Book

Other

(please describe)_________________________________________

relied upon by the undersigned:

Garageman (a copy of proof of business must be attached [see MV-901DI]):

Business Name:___________________________________________________ Facility # ___________________

Government Issued ID for person

submitting this form (copy must be

Business Address:______________________________________________________ Apt./STE# ____________

attached):

No.:_________________________

City:__________________________________________

State: ___________

Zip Code ______________

Vehicle Dismantler or Scrap Processor

Government Issued ID for

Business Name:___________________________________________________ Facility # ___________________

representative of vehicle dismantler

or scrap processor (copy must be

Business Address:_______________________________________________________ Apt./STE# ____________

attached):

No.:_________________________

City:__________________________________________

State: ___________

Zip Code_______________

Prior Owner (a copy of verification of prior owner and other lienholders must be attached):

Name: ___________________________________________________________________________________________________________________

Street

Address:______________________________________ Apt./STE# ______City:__________________________ State: ______ Zip Code___________

Lienholders (

Attach additional sheet, if necessary)

Business Name:_______________________________________________

Business Name:________________________________________________

Business

Address:______________________________________ Apt./STE# ______

City:__________________________ State: ______ Zip Code__________

Service of Notice and Towing and/or Storage Information

(a copy of the Notice of Lien and Sale, and a copy of receipt for mailing must be

[see MV-901DI]):

attached

Date of Service of Notice to Owner: _______/_______/_______ Date of Service of Notice to Lienholder(s): ______/_______/_______

Date Vehicle was Towed :

Date Storage Began:

Date of Sale:

(Towing authorization must be attached)

10.

______ / _______ / ________

I further certify that: the Date of Sale is not (a) prior to thirty days after the date on which Service of Notice was mailed, or (b) prior to sixty days after the

date of the initial tow, whichever is later; no action was brought under Section 201-a of the Lien Law, or, an action was brought and the determination was

in my (our) favor; and the required Notice of Lien was sent to owner(s) and lienholder(s). Proof of certified mailing is attached.

GARAGEMAN’S/REPRESENTATIVE’S NAME - Print

GARAGEMAN’S/REPRESENTATIVE’S TITLE

GARAGEMAN’S/REPRESENTATIVE’S SIGNATURE - Please sign name in full

DATE

MV-901D (11/15)

reset/clear