Form MV-83sal Salvage Examination/Title Application - New York

Form MV-83sal or the "Salvage Examination/title Application" is a form issued by the New York State Department of Motor Vehicles.

Download a fillable PDF version of the Form MV-83sal down below or find it on the New York State Department of Motor Vehicles Forms website.

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SALVAGE EXAMINATION/TITLE APPLICATION
For more information on salvage,
visit dmv.ny.gov
o
o
o
A. Salvage Exam & Title
B. Salvage Exam Only
C. Salvage Exam Reapplication
I AM APPLYING FOR:
Your current
determines the total fee you must pay. Make your check or money order payable to
proof of ownership
“Commissioner of Motor Vehicles”.
A.
New York State title/Out-of-state title/Marshall’s sale/Police Bill of Sale/Garageman Lien:
l
$205.00
New York State Salvage Certificate (MV-907A):
l
$200.00
B. If your vehicle is already registered in NY(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.
NAME OF PRIMARY OWNER (Last, First, Middle)
NYS driver license number of PRIMARY
SEX
DATE OF BIRTH
Month
Day
Year
M F
o o
NAME OF CO-OWNER (Last, First, Middle)
NYS driver license number of CO-OWNER
SEX
DATE OF BIRTH
Month
Day
Year
M F
o o
CONTACT TELEPHONE # (Required)
Is this a corporation or partnership?
Area Code
o
o
Yes
No
(
)
THE ADDRESS WHERE PRIMARY OWNER GETS MAIL
(Include Street Number and Name, Rural Delivery or box number. This address will be on the document.)
Apt. No.
City or Town
State
Zip Code
County of Residence
THE ADDRESS WHERE PRIMARY OWNER RESIDES IF DIFFERENT FROM THE MAILING ADDRESS
(DO NOT GIVE A P.O. BOX.)
.
Apt. No.
City or Town
State
Zip Code
VEHICLE IDENTIFICATION NUMBER
VEHICLE DESCRIPTION
Year
Make
Body Type For Other Vehicles (mark one)
Body Type For Cars (mark one)
Color
Unladen Weight
Station Wagon or
Pick-up
Tow
o
o
o
o
o
o
o
o
o
o
o
Van
Motorcycle
Trailer
Other
2-Door
4-Door
Convertible
Suburban
Other
Truck
Truck
Type of Power (Fuel)
For trailers & commercial vehicles
For rentals,buses & taxis
For commercial vehicles
o
o
o
o
Cylinders
Maximum Gross Weight
Seating Capacity
Axles
Distance
Gas
Diesel
Electric
Flex
o
o
o
o
CNG
Propane
Hybrid
None
Odometer Disclosure/Reading in Miles
o
o
o
I certify that the odometer reading of
is
Actual,
Not Actual, or
Exceeds mechanical limits.
Lien Filing Code
Lienholder Name and
NY
Mailing Address
DEALER
(Assigned
ONLY
by DMV)
(If you want the examination notice sent to another address, or by email, please complete the following):
EMAIL AND ALTERNATE ADDRESS
Name (Use Corporate
Name, if applicable)
Address (Number
Apt. #
and Street)
City
State
ZIP Code
*
Home Telephone No.
Business Telephone No.
E-mail Address
(
)
(
)
(Please print clearly)
*
*
EMAIL NOTIFICATION: If you have provided your email address, the email notice you receive WILL BE THE ONLY NOTIFICATION SENT TO YOU.
Please save and print that notice as you will NOT receive a letter by regular mail.
I request that the vehicle be examined at the following location:
APPOINTMENT SITES:
__ Buffalo
__ Binghamton**
__ Utica
__ Albany
__ Bronx
(serves Westchester & Bronx counties)
__ Rochester
__ Highland (
__ Canton**
__ Plattsburgh**
__ Queens Village
serves Ulster/
(serves New York/Queens/
__ Horseheads**
__ Oxford**
Putnam/Dutchess/Orange &
Kings & Richmond counties)
__ Syracuse
Rockland Counties
__ West Babylon
(serves Nassau & Suffolk counties)
Only occasional service is offered at this location.
**NOTE:
o
o
Do you need a permit to drive the vehicle to/from the exam location? (NYS residents only)
Yes
No
If yes, please include:
current proof of NYS insurance (a copy of form FS-20 or form FS-21)
l
NYS Safety/emissions Inspection report showing “passed”
l
If you do not provide a completed application, the proper forms, fees and signatures,
your application and check or money order will be returned to you.
PAGE 1 OF 2
MV-83SAL (3/18)
SALVAGE EXAMINATION/TITLE APPLICATION
For more information on salvage,
visit dmv.ny.gov
o
o
o
A. Salvage Exam & Title
B. Salvage Exam Only
C. Salvage Exam Reapplication
I AM APPLYING FOR:
Your current
determines the total fee you must pay. Make your check or money order payable to
proof of ownership
“Commissioner of Motor Vehicles”.
A.
New York State title/Out-of-state title/Marshall’s sale/Police Bill of Sale/Garageman Lien:
l
$205.00
New York State Salvage Certificate (MV-907A):
l
$200.00
B. If your vehicle is already registered in NY(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.
NAME OF PRIMARY OWNER (Last, First, Middle)
NYS driver license number of PRIMARY
SEX
DATE OF BIRTH
Month
Day
Year
M F
o o
NAME OF CO-OWNER (Last, First, Middle)
NYS driver license number of CO-OWNER
SEX
DATE OF BIRTH
Month
Day
Year
M F
o o
CONTACT TELEPHONE # (Required)
Is this a corporation or partnership?
Area Code
o
o
Yes
No
(
)
THE ADDRESS WHERE PRIMARY OWNER GETS MAIL
(Include Street Number and Name, Rural Delivery or box number. This address will be on the document.)
Apt. No.
City or Town
State
Zip Code
County of Residence
THE ADDRESS WHERE PRIMARY OWNER RESIDES IF DIFFERENT FROM THE MAILING ADDRESS
(DO NOT GIVE A P.O. BOX.)
.
Apt. No.
City or Town
State
Zip Code
VEHICLE IDENTIFICATION NUMBER
VEHICLE DESCRIPTION
Year
Make
Body Type For Other Vehicles (mark one)
Body Type For Cars (mark one)
Color
Unladen Weight
Station Wagon or
Pick-up
Tow
o
o
o
o
o
o
o
o
o
o
o
Van
Motorcycle
Trailer
Other
2-Door
4-Door
Convertible
Suburban
Other
Truck
Truck
Type of Power (Fuel)
For trailers & commercial vehicles
For rentals,buses & taxis
For commercial vehicles
o
o
o
o
Cylinders
Maximum Gross Weight
Seating Capacity
Axles
Distance
Gas
Diesel
Electric
Flex
o
o
o
o
CNG
Propane
Hybrid
None
Odometer Disclosure/Reading in Miles
o
o
o
I certify that the odometer reading of
is
Actual,
Not Actual, or
Exceeds mechanical limits.
Lien Filing Code
Lienholder Name and
NY
Mailing Address
DEALER
(Assigned
ONLY
by DMV)
(If you want the examination notice sent to another address, or by email, please complete the following):
EMAIL AND ALTERNATE ADDRESS
Name (Use Corporate
Name, if applicable)
Address (Number
Apt. #
and Street)
City
State
ZIP Code
*
Home Telephone No.
Business Telephone No.
E-mail Address
(
)
(
)
(Please print clearly)
*
*
EMAIL NOTIFICATION: If you have provided your email address, the email notice you receive WILL BE THE ONLY NOTIFICATION SENT TO YOU.
Please save and print that notice as you will NOT receive a letter by regular mail.
I request that the vehicle be examined at the following location:
APPOINTMENT SITES:
__ Buffalo
__ Binghamton**
__ Utica
__ Albany
__ Bronx
(serves Westchester & Bronx counties)
__ Rochester
__ Highland (
__ Canton**
__ Plattsburgh**
__ Queens Village
serves Ulster/
(serves New York/Queens/
__ Horseheads**
__ Oxford**
Putnam/Dutchess/Orange &
Kings & Richmond counties)
__ Syracuse
Rockland Counties
__ West Babylon
(serves Nassau & Suffolk counties)
Only occasional service is offered at this location.
**NOTE:
o
o
Do you need a permit to drive the vehicle to/from the exam location? (NYS residents only)
Yes
No
If yes, please include:
current proof of NYS insurance (a copy of form FS-20 or form FS-21)
l
NYS Safety/emissions Inspection report showing “passed”
l
If you do not provide a completed application, the proper forms, fees and signatures,
your application and check or money order will be returned to you.
PAGE 1 OF 2
MV-83SAL (3/18)
TYPE OF SALVAGE (check all boxes that apply to your vehicle):
o
o
o
o
Recovered Stolen With No Damage
Recovered Stolen (with damage)
Collision Loss
Flood Damage
o
Other/Unknown (explain)
MAJOR BODY PARTS, POWER TRAIN, AND AIRBAGS REPLACED (you must check either Yes or No for each item):
YES NO
YES NO
YES NO
YES NO
YES NO
o o
Vehicle Identification
o o
o o
o o
o o
Right 3/4 Nose
Rear Clip
Frame (Repair or
Driver Air Bag
Number Plate Missing,
Replacement)
o o
o o
o o
Nose (Complete)
Cowls
Passenger Air Bag
Altered or Defaced
o o
Engine
o o
o o
o o
Body
Front Cut Off
Other Air Bags
o o
Left 3/4 Nose
o o
Transmission
o
Not required for Bikes, trailers, etc.
ITEMIZED BODY REPAIR (you must check either Yes or No for each item):
YES NO
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
Receipts for Repairs: At the time of examination, you MUST present original receipts and/or ownership documents for items replaced (those
noted above under Major Body Parts, Power Train, Airbags and the Itemized Body Repair check list). They must show the stock number and
vehicle identification number (VIN) for the replacement item.
CHECKLIST TO AVOID REJECTION OF APPLICATION: (Please make sure all required forms are properly completed and signed)
o
o
MV-83SAL
Original Lien or Lien Release
(if applicable)
o
o
Proof of Identity
:
Check or Money Order with correct fee
(as listed below)
Individuals - NY residents: a copy of your current NYS driver license or NYS
o
Original Proof of Ownership
*
non-driver ID card. Non-Residents: 6 points of ID (refer to form ID-82).
Once approved, original documents cannot be returned.
Corporations - A copy of your Certificate of Incorporation, or a NYS vehicle
o Original
Bill of Sale and/or Dealer Reassignment
registration or title in the corporation’s name, or a NYS Department of State
*
(if applicable)
(DOS) filing receipt, or assumed name (DBA), or a certificate of good standing.
o
Proof of Sales Tax Paid
(form FS-6T or form MV-50)
Partnerships - Your Certificate of Partnership or DBA filing receipt from your
*
County Clerk, or Statement of Partnership or Joint Ownership (form MV-83T).
Must have both buyer and seller signatures
If you have questions about your application regarding:
Mail your completed application and fee to:
Examination Scheduling, call: (518) 474-0955 Monday - Friday 9:00am - 4:00pm
AUTO THEFT & SALVAGE UNIT
l
DFI P.O. Box 2105 Empire State Plaza
Application and Title, call: (518) 473-0399 Tuesday - Thursday 9:00am - 4:00pm
l
Albany NY 12220-0105
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 DFICancel@dmv.ny.gov 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 form MV-83SAL and paying a new fee of $150.00, or pay with a credit card by calling (518) 486-9786.
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 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.
CERTIFICATION: I certify that, to the best of my knowledge, the information provided on this form is true and complete.
Primary Owner
Co-Owner
Print Name:
Print Name:
Signature
Signature
X
X
(Sign Name in Full)
(Sign Name in Full)
Dealer
Signature
DMV Facility
)
(if applicable
Number
Date:
(if applicable)
X
MV-83SAL (3/18)
PAGE 2 OF 2
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Download Form MV-83sal Salvage Examination/Title Application - New York

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