Application For Oklahoma Certificate Of Title For A Vehicle Page 2
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2Form 701-6 Part 2
Declaration of Damage or Theft
The owner/legal agent of owner of the vehicle described on the reverse side of this application must complete the follow-
ing Declaration.
(1) Has the vehicle been damaged by collision or other occurrence?
______ Yes
______ No
(2) Has the vehicle been recoverd from a theft?
______ Yes
______ No
If the answer to either of the above questions is yes, the owner/legal agent declares, to the best of his/her knowledge:
(3) The cost of repairing the vehicle to a roadworthy condition amounted to _____________ % (percent) of its fair market
vaule at the time of loss.
Flood Damage Disclosure
If the vehicle has been subject to flood or water damage, the owner/legal agent is to also review and answer the following:
47 O.S. Section 1105 defines “Flood-damaged vehicle” as follows:
Flood-damaged vehicle means a salvage or rebuilt vehicle which was damaged by flooding, or a vehicle which was
submerged at a level to or above the dashboard of the vehicle and on which an amount of loss was paid by the insurer.
(4) Did the flood/water damage to your vehicle meet the above criteria?
______ Yes
______ No
___________________________________________________
_________________________
Owner or legal agent of owner
Date
Vehicle Inspection
Vehicle Identification Number: _______________________________________________________________________
Odometer Reading: _______________________________________________________________________________
I, the undersigned, hereby certify that I have physically inspected the vehicle identification number and odometer reading
of the described vehicle, confirming each as entered directly above.
___________________________________________________
_________________________
Inspector
Date
___________________________________________________
Title or Position
________________________________________
___________
___________________________________
City
State
Motor License Agent Number
(if applicable)
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