Form Sfn 18609 - Damage/salvage Disclosure Statement
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1Motor Vehicle Division
DAMAGE/SALVAGE DISCLOSURE STATEMENT
ND Department of Transportation
North Dakota Department of Transportation, Motor Vehicle Division
608 East Boulevard Avenue
SFN 18609 (Rev. 07-2009)
Bismarck, ND 58505-0780
Telephone (701) 328-2725
Fax (701) 328-1487
Web site:
This form must be completed for all vehicles less than nine (9) model years old.
This form must be signed by the transferor (seller), given to the transferee (buyer), and accompany the application for title when
submitted by the transferee (buyer).
Transferee (Buyer) Legal Name
Daytime Telephone Number
Address
City
State
Zip Code
Year
Make
Model
Style
Vehicle Identification Number
Title Number
Name of Transferor (Seller)
Daytime Telephone Number
Address
City
State
Zip Code
A person repairing, replacing parts, or performing body work on a motor vehicle that is less than nine (9) years old shall
provide a statement to the owner of the motor vehicle when the motor vehicle has sustained motor vehicle damage requiring
disclosure under this section. The owner shall disclose this damage when ownership of the motor vehicle is transferred.
When a vehicle is damaged in excess of seventy-five percent of its retail value as determined by the national automobile
dealers association official used car guide, the person repairing, replacing parts, or performing body work on the motor
vehicle that is less than nine (9) years old shall also advise the owner of the motor vehicle that the owner of the vehicle must
comply with section 39-05-20.2. (See Below)
The amount of damage to a motor vehicle is determined by adding the retail value of all labor, parts, and material used in
repairing the damage. When the retail value of labor has not been determined by a purchase in the ordinary course of
business, for example when the labor is performed by the owner of the vehicle, the retail value of the labor is presumed to
be the product of the repair time, as provided in a generally accepted autobody repair flat rate manual, multiplied by thirty-
five dollars.
DAMAGE DISCLOSURE: NDCC 39-05-17.2
Within the past eight (8) years, has this vehicle sustained body or structural damage from a vehicular crash or accident, including loss by fire,
vandalism, weather, or submersion in water, resulting in damage to the motor vehicle which equals or exceeds the greater of $8,000 or forty
percent of the predamage retail value of the motor vehicle as determined by the national automobile dealers association official used car
guide? The term does not include body or structural modifications, normal wear and tear, glass damage, hail damage, or items of normal
maintenance and repair.
Type of Damage
Collision
Weather
Theft
Interior
Other
Yes
No
(check all that apply)
Under Carriage
Water
Vandalism
Fire
Yes
No
Has this vehicle been damaged in excess of seventy-five percent (75%) of its retail value?
Explanation of Damage
Signature of Transferor (Seller)
Date
X
Any person who makes a false statement on this form is guilty of a Class A Misdemeanor.
SALVAGE CERTIFICATE OF TITLE: NDCC 39-05-20.2
The owner of a vehicle that is damaged in excess of seventy-five percent of its retail value as determined by the national
automobile dealers association official used car guide, shall forward the title for that vehicle to the department within ten
days and the department shall issue a salvage certificate of title. Glass damage and hail damage must be excluded in the
determination of whether a vehicle has been damaged in excess of seventy-five percent of the vehicle's retail value. If a
vehicle for which a salvage certificate of title has been issued is reconstructed, a regular certificate of title may be obtained
by completing an application for the certificate. The applicant shall include with the application a certificate of inspection in
the form required by the department, the salvage certificate of title, and a five dollar fee. The department shall place on the
regular certificate of title and on all subsequent certificates of title issued for the vehicle, a notation that damage disclosure
information is available from the department. The department may not issue a new certificate unless the vehicle identi-
fication number of the vehicle has been inspected and found to conform to the description given in the application, or unless
other proof of the identity of the vehicle has been provided to the satisfaction of the department.
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