Fillable Printable Form MV83-SAL - Salvage Examination/Title Application - New York

Form MV83-SAL - Salvage Examination/Title Application - New York

Is this a corporation or partnership?

o Yes o No

M F

Year Make

Color

Unladen Weight

Cylinders

Area Code

( )

Maximum Gross Weight

NAME OF PRIMARY OWNER (Last, First, Middle)

NYS driver license number of PRIMARY

SEX

THE ADDRESS WHERE PRIMARY OWNER GETS MAIL

For trailers & commercial vehicles

For commercial vehicles

For rentals,buses & taxis

VEHICLE DESCRIPTION

Body Type For Cars (mark one)

Body Type For Other Vehicles (mark one)

Type of Power (Fuel)

VEHICLE IDENTIFICATION NUMBER

Odometer Disclosure/Reading in Miles

DAY TELEPHONE (Optional)

Month Day Year

DATE OF BIRTH

Month Day Year

Axles

Distance

Lienholder Name and

Mailing Address

Lien Filing Code

(Assigned

by DMV)

Apt. No. City or Town State Zip Code County of Residence

Apt. No. City or Town State Zip Code

SALVAGE EXAMINATION/TITLE APPLICATION

For more information on salvage, visit www.dmv.ny.gov

THE ADDRESS WHERE PRIMARY OWNER RESIDES IF DIFFERENT FROM THE MAILING ADDRESS.

(DO NOT GIVE A P.O. BOX.)

(Include Street Number and Name, Rural Delivery or box number. This address will be on the document.)

PAGE 1 OF 2

MV-83SAL (10/15)

DEALER

ONLY

Seating Capacity

Station Wagon or

o 2-Door o 4-Door o Convertible o Suburban oOther______________

ooVan oMotorcycle ooTrailer oOther _______________

M F

NAME OF CO-OWNER (Last, First, Middle)

NYS driver license number of CO-OWNER

SEX

DATE OF BIRTH

Pick-up

Truck

Tow

Truck

I AM APPLYING FOR:

Use the current proof of ownership to determine your total fee:

A.l New York State Salvage Certificate (MV-907A) $200.00

l 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 (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.

If you do not provide the proper forms, fees and signatures,

your application and check/money order will be returned to you.

City

State ZIP Code

Apt. #

Business Telephone No.

( )

E-mail Address

EMAIL AND ALTERNATE ADDRESS (If you want the examination notice sent to another address, or by email, please complete the following):

Name (Use Corporate

Name, if applicable)

Address (Number

and Street)

Home Telephone No.

( )

APPOINTMENT SITES: I request that the vehicle be examined at the following location:

__ Buffalo

__ Rochester

__ Horseheads*

__ Syracuse

__ Binghamton*

__ Highland

__ Utica

__ Canton*

__ Oxford*

__ Albany

__ Plattsburgh*

__ Elmsford (serves Putnam/Westchester/Rockland & Bronx counties)

__ Queens Village (serves New York/Queens/Kings & Richmond counties)

__ West Babylon (serves Nassau & Suffolk counties)

*NOTE: Only occasional service is offered at this location.

o A. Salvage Exam & Title o B. Salvage Exam Only o C. Salvage Exam Reapplication

Do you need a permit to drive the vehicle to/from the exam location (NYS residents only)

o Yes o No

If yes, please include:

l current proof of NYS insurance - copy of FS-20 or FS-21

l NYS Safety/emissions Inspection receipt showing “passed”

I certify that the odometer reading of ____________________________________________________________________________ is o Actual, o Not Actual, or o Exceeds mechanical limits.

Email notification: If you have requested to be notified by both regular mail and email, the email sent to you will constitute formal notice.

o Gas oDiesel o Electric o Flex

o CNG o Propane o Hybrid o None

MV-83SAL (10/15)

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WARNING: Intentionally making a false statement or providing false or misleading information in connection with this application is a criminal offense that

may subject you to criminal prosecution under the law. The conduct of an examination of subject vehicle by DMV does not constitute any representation

concerning the safety of the vehicle. The act of submitting a vehicle for examination by DMV shall constitute a waiver of all claims of liability to DMV and

the State of New York respecting the subsequent operation of the vehicle.

CHECKLIST TO AVOID REJECTION OF APPLICATION:

CERTIFICATION: I certify that, to the best of my knowledge, the information provided on this form is true and complete.

Print Name: __________________________________________ DMV Facility Number (if applicable) _____________________

Signature: ___________________________________________ Date __________________________

(Sign Name in Full)

The Division of Field Investigation will notify you by mail/email of the date, time and address of your appointment. You may postpone your scheduled

appointment if you give two business days (48 hours) notice by emailing [email protected] or calling (518) 474-0955. However, you may reschedule

only one time.

If you do not keep a scheduled appointment, your fee will be forfeited and you must reapply by completing MV-83SAL and paying a new fee

of $150.00, or paying with a credit card by calling (518) 486-9786.

o o Vehicle Identification

Number Plate Missing,

Altered or Defaced

o o Left 3/4 Nose

o o Rear Clip

o o Cowls

o o Front Cut Off

YES NO

o o Right 3/4 Nose

o o Nose (Complete)

o o Body

YES NO

o o Frame (Repair or

Replacement)

o o Engine

o o Transmission

YES NO

o o Driver Air Bag

o o Passenger Air Bag

o o Other Air Bags

YES NO

TYPE OF SALVAGE (check all boxes that apply to your vehicle):

o Recovered Stolen With No Damage o Recovered Stolen (with damage) o Collision Loss o Flood Damage

o Other (explain)______________________________________________________________________________________________________________

MAJOR BODY PARTS, POWER TRAIN, AND AIRBAGS REPLACED

(you must check each box either Yes or No):

ITEMIZED BODY REPAIR

(you must check each box either Yes or No):

If you have questions regarding your application:

l Examination Scheduling Related: (518) 474-0955 Monday - Friday 9:00am - 4:00pm

l Application and Title related: (518) 473-0399 Tuesday - Thursday 9:00am - 4:00pm

Mail your completed application and fee to:

AUTO THEFT & SALVAGE UNIT

DFI P.O. Box 2105 Empire State Plaza

Albany NY 12220-0105

o o 1. Bumper/Grill

o o 2. Radiator Support

o o 3. Hood

o o 4. Left Front Fender

o o 5. Left Front Door

o o 6. Left Center Pillar

o o 7. Left Rear Door

o o 8. Left Rear 1/4 Panel

o o 9. Rear Bumper

o o 10. Trunk Lid

o o 11. Right Rear 1/4 Panel

o o 12. Roof

o o 13. Right Rear Door

o o 14. Right Center Pillar

o o 15. Right Front Door

o o 16. Right Front Fender

o o 17. Frame

o MV-83SAL o Check or Money Order with correct fee o Original Proof of Ownership o Original Lien or Lien Release (if applicable)

o Proof of Sales Tax Paid (FS-6T or MV-50) o Original Bill of Sale or Dealer Reassignment o Proof of Identity as described below:

Individuals - NY residents: a copy of your current NYS driver license or NYS Non-Driver ID Card. Non-Residents: 6 points of ID (refer to ID-82).

Corporations - a copy of your Certificate of Incorporation, or a NYS vehicle registration or title in the corporation’s name, or a NYS Department of State

(DOS) filing receipt, or assumed name (DBA), or a certificate of good standing.

Partnerships - your Certificate of Partnership or DBA filing receipt from your County Clerk, or Statement of Partnership or Joint Ownership (MV-83T).

*Receipts for Repairs: If any major component part has been replaced, you MUST present sales receipts at the time of the vehicle examination. The receipts

must show the stock number and vehicle identification number of any replacement parts used for the vehicle.

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