Application Form For Nonrepairable Or Salvage Certificate Page 2
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1
2INSTRUCTIONS
If Block 1 is checked: Complete Sections A, B, C (if applicable) and F.
G G
The applicant completing this application must be either the owner whose name appears on the
face of the attached Certificate of Title, or if the title is assigned, the last assignee whose name
appears on the reverse side of the title. NOTE: Individuals should list their PA Driver’s License
(PA DL) or Photo ID# in the space provided. Businesses should list their Business ID# (Bus. ID)
where indicated (i.e. E.I.N.).
Certificate of title currently in the name of (or assigned to) the applicant must accompany this
application.
If an out-of-state title is attached, a title fee of $22.50 must accompany this application if the title
is assigned to an individual within PA who is also reassigning to another individual in PA.
If an out-of-state title is attached and the title is reassigned to a PA dealer OR the title is
assigned to an individual with a PA residence, then NO FEE IS REQUIRED.
If an out-of-state title is attached, Section C must be completed and a tracing of the VIN must
be attached. If the VIN tracing cannot be obtained, the vehicle identification number must be
verified by a certified inspection mechanic OR an authorized notary public employed by a full
agent or a motor vehicle dealer.
NOTE: If the vehicle is a total loss due to flood, please check the appropriate block. A
salvage certificate will be issued with a “W” brand.
If the vehicle is a total loss due to theft, please check the appropriate block. A
salvage certificate will be issued with a “N” brand. A copy of the police report,
indicating that the vehicle was stolen, must be attached or Section E must be
completed.
If Block 2 is checked: Complete Sections A, B, D and F.
G G
When a Certificate of Salvage has been lost, stolen, defaced, or never received, the owner on
the front of the original certificate may obtain a duplicate. (No fee required.)
If Block 3 is checked: Complete Sections A, B, C and F.
G G
When a Nonrepairable Certificate is issued, the vehicle may ONLY be used as a source for parts
or scrap and may NOT be issued a Certificate of Title or Certificate of Salvage.
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