Form MVT-103 "Affidavit of Rebuilt or Repaired Salvage Vehicle" - Maine

What Is Form MVT-103?

This is a legal form that was released by the Maine Department of the Secretary of State - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the Maine Department of the Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MVT-103 by clicking the link below or browse more documents and templates provided by the Maine Department of the Secretary of State.

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Download Form MVT-103 "Affidavit of Rebuilt or Repaired Salvage Vehicle" - Maine

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AFFIDAVIT OF REBUILT OR
SECRETARY OF STATE
REPAIRED SALVAGE VEHICLE
BUREAU OF MOTOR VEHICLES
VEHICLE SERVICES - TITLE SECTION
Final Vehicle Owner
____________________________________________________
Name:
Vehicle Make: _____________________
____________________________________________________
Address:
Vehicle Model: _____________________
City:
____________________________________ VIN: ________________________________________________________
State: ________ ZIP ______________ Phone: (______) __________________ CTA#: ____________________R ___________
Instructions for Part A: Use Part A to list parts used in the repair of the salvage vehicle. In the “KEY” section beside each part listed
indicate whether the component was replaced with a new part (N), or a used part (U), or if the part was repaired (R) instead of replaced.
Bills of sale for new components must accompany this form. For used parts list VIN and title information below.
KEY
L-Left
TITLE
TITLE
DATE
PART
N/U/R
R-Right
VIN
STATE
NUMBER
SURRENDERED
FENDER
FRONT DOOR
REAR DOOR
QUARTER
Serial Number(s) for each new airbag
AIRBAG (S)
Record VIN if used airbag
AIRBAG (S)
If a full clip is used, record VIN
COMPLETE
FRONT CLIP
If a full clip is used, record VIN
COMPLETE
REAR CLIP
ROOF
HOOD
TAILGATE/HB/LID
CARGO BED
FRAME
ENGINE
TRANSMISSION
TRANSFER CASE
FRONT FORK (MC)
CRANKCASE (MC)
 No repairs made. (Please explain):
_________________________________________________________________________
Date: __________________ Repairer’s signature: ______________________________________________________________________
Address: ______________________________________________________________ Telephone: _______________________________
I, the above signed, under penalties of false statement do certify the information in Part A is true and correct to the best of my knowledge.
101 Hospital Street, #29 State House Station, Augusta, ME 04333-0029
Tel. (207) 624-9000 Ext. 52138 FAX: 624-9254 TTY Users call Maine relay 711
MVT-103 REV. 01/2013
AFFIDAVIT OF REBUILT OR
SECRETARY OF STATE
REPAIRED SALVAGE VEHICLE
BUREAU OF MOTOR VEHICLES
VEHICLE SERVICES - TITLE SECTION
Final Vehicle Owner
____________________________________________________
Name:
Vehicle Make: _____________________
____________________________________________________
Address:
Vehicle Model: _____________________
City:
____________________________________ VIN: ________________________________________________________
State: ________ ZIP ______________ Phone: (______) __________________ CTA#: ____________________R ___________
Instructions for Part A: Use Part A to list parts used in the repair of the salvage vehicle. In the “KEY” section beside each part listed
indicate whether the component was replaced with a new part (N), or a used part (U), or if the part was repaired (R) instead of replaced.
Bills of sale for new components must accompany this form. For used parts list VIN and title information below.
KEY
L-Left
TITLE
TITLE
DATE
PART
N/U/R
R-Right
VIN
STATE
NUMBER
SURRENDERED
FENDER
FRONT DOOR
REAR DOOR
QUARTER
Serial Number(s) for each new airbag
AIRBAG (S)
Record VIN if used airbag
AIRBAG (S)
If a full clip is used, record VIN
COMPLETE
FRONT CLIP
If a full clip is used, record VIN
COMPLETE
REAR CLIP
ROOF
HOOD
TAILGATE/HB/LID
CARGO BED
FRAME
ENGINE
TRANSMISSION
TRANSFER CASE
FRONT FORK (MC)
CRANKCASE (MC)
 No repairs made. (Please explain):
_________________________________________________________________________
Date: __________________ Repairer’s signature: ______________________________________________________________________
Address: ______________________________________________________________ Telephone: _______________________________
I, the above signed, under penalties of false statement do certify the information in Part A is true and correct to the best of my knowledge.
101 Hospital Street, #29 State House Station, Augusta, ME 04333-0029
Tel. (207) 624-9000 Ext. 52138 FAX: 624-9254 TTY Users call Maine relay 711
MVT-103 REV. 01/2013
DISPOSITION OF SALVAGE VEHICLE
SECRETARY OF STATE
BUREAU OF MOTOR VEHICLES
VEHICLE SERVICES - TITLE SECTION
PART B
NOTICE: You must surrender the title of a salvage vehicle to the Maine Bureau of Motor Vehicles as soon as you remove any
component part as listed in Part A of the reverse of this form, or as soon as a salvage vehicle is scrapped, compressed or destroyed, even if
the title is from another state.
INSTRUCTIONS: Use Part B to inform the Secretary of State that a salvage vehicle has been scrapped, dismantled, compressed or
destroyed. (If the salvage vehicle has been rebuilt use Part A on the reverse of this form.) A salvage vehicle is any vehicle for which an
insurance company has made a total loss payoff or which an owner declares is only useful for parts.
PERSON OR COMPANY SURRENDERING TITLE (S)
NAME______________________________________________________________________________________
ADDRESS __________________________________________________________________________________
TITLES SURRENDERED
TITLE NUMBER
STATE
VIN
Under penalties of false statement, I, the undersigned, certify that the vehicles described in the attached certificates of title were scrapped,
dismantled, compressed or destroyed.
Signature: ____________________________________________________________________ Date: ____________________________
Note: Make sure your name is on the back of every surrendered title or on a transfer form attached to the title.
101 Hospital Street, #29 State House Station, Augusta, ME 04333-0029
Tel. (207) 624-9000 Ext. 52138 FAX: 624-9254 TTY Users call Maine relay 711
MVT-103 REV. 1-2013
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