Form VR-454 "Affidavit of Lawful Possession for Transfer of a Vehicle to an Automotive Dismantler and Recycler or Scrap Processor" - Maryland

What Is Form VR-454?

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

Form Details:

  • Released on October 1, 2012;
  • The latest edition provided by the Maryland Department of Transportation;
  • 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 VR-454 by clicking the link below or browse more documents and templates provided by the Maryland Department of Transportation.

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Download Form VR-454 "Affidavit of Lawful Possession for Transfer of a Vehicle to an Automotive Dismantler and Recycler or Scrap Processor" - Maryland

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Motor Vehicle Administration
VR-454 (10-12)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Affidavit of Lawful Possession for Transfer of a Vehicle to an Automotive Dismantler and Recycler or Scrap Processor
Purpose:
Use this form to certify, under oath, that a Certificate of Title is unavailable for a vehicle that is being transferred to an Automotive
Dismantler and Recycler or Scrap Processor for purposes of dismantling, destroying or scrapping, and that proper notification has
been made pursuant to Maryland law.
Instructions:
Complete form in its entirety. This form must be maintained at the place of business and made available upon request to the MVA or
Law Enforcement Officials for a period of at least 3 years. MUST ATTACH:
1. A COPY OF THE DRIVER’S LICENSE OF THE PERSON PROVIDING THE VEHICLE; AND
2. BEFORE THE VEHICLE CAN BE DISMANTLED, DESTROYED OR SCRAPPED, COPIES OF VEHICLE OWNER AND LIEN
HOLDER NOTIFICATIONS.
Limitations:
A vehicle may not be retitled or assigned using this document; it may only be dismantled, destroyed or scrapped. This form cannot
be used for a vehicle towed from a residential or commercial property under a continuing contract to tow unauthorized vehicles.
PROVIDER’S INFORMATION
PROVIDER’S NAME (PRINT)
PROVIDER’S DRIVER’S LICENSE NUMBER
COMPANY NAME
COMPANY PHONE
COMPANY STREET ADDRESS
CITY
STATE
ZIP
q
q
IS THE VEHICLE BEING TRANSPORTED BY A TOW VEHICLE?
YES – ATTACH COPY OF REGISTRATION
NO
NAME OF PERSON AND OR COMPANY AUTHORIZING THE TOW: ________________________________________________________
VEHICLE OWNER INFORMATION
OWNER NAME (PRINT)
CO-OWNER NAME (PRINT)
VEHICLE INFORMATION
YEAR
MAKE
MODEL
BODY STYLE
COLOR
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE INFORMATION CERTIFICATION
Knowingly making a false statement on this form is punishable by a penalty not exceeding: $1,000, or 10 years imprisonment, or both.
Any willful misinformation provided with fraudulent intent may be prosecuted under Maryland law.
I solemnly affirm, under penalties of perjury, and upon personal knowledge, the contents of the foregoing paper are true to the best of my knowledge and/or
belief. I have the lawful right to possess the vehicle.
PRINTED NAME OF PROVIDER
SIGNATURE OF PROVIDER
DATE
NOTIFICATION CERTIFICATION
Any willful misinformation provided with fraudulent intent may be prosecuted under Maryland law.
I hereby certify, under penalties of perjury, that all required notifications to vehicle owner and lien holder (if applicable) have been made, pursuant to Maryland
law (TR 15-509 and 25-209), and documentation showing such notification is attached.
PRINTED NAME OF PERSON MAKING THE NOTIFICATION
DATE VEHICLE ACQUIRED
SIGNATURE OF PERSON CERTIFYING THE NOTIFICATION
AUTOMOTIVE DISMANTLER AND RECYCLER OR SCRAP PROCESSOR INFORMATION
COMPANY NAME (PRINT)
LICENSEE’S NAME
LICENSE NUMBER
STREET ADDRESS
CITY
STATE
ZIP
LOCATION WHERE VEHICLE IS BEING HELD (IF DIFFERENT FROM ABOVE)
In processing this vehicle, I affirm to the best of my knowledge and belief that I have complied with all applicable Federal and State laws.
PRINTED NAME
AUTHORIZED SIGNATURE
DATE
For more information, please call: 410-768-7000 (to speak with a customer service representative).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov
Motor Vehicle Administration
VR-454 (10-12)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Affidavit of Lawful Possession for Transfer of a Vehicle to an Automotive Dismantler and Recycler or Scrap Processor
Purpose:
Use this form to certify, under oath, that a Certificate of Title is unavailable for a vehicle that is being transferred to an Automotive
Dismantler and Recycler or Scrap Processor for purposes of dismantling, destroying or scrapping, and that proper notification has
been made pursuant to Maryland law.
Instructions:
Complete form in its entirety. This form must be maintained at the place of business and made available upon request to the MVA or
Law Enforcement Officials for a period of at least 3 years. MUST ATTACH:
1. A COPY OF THE DRIVER’S LICENSE OF THE PERSON PROVIDING THE VEHICLE; AND
2. BEFORE THE VEHICLE CAN BE DISMANTLED, DESTROYED OR SCRAPPED, COPIES OF VEHICLE OWNER AND LIEN
HOLDER NOTIFICATIONS.
Limitations:
A vehicle may not be retitled or assigned using this document; it may only be dismantled, destroyed or scrapped. This form cannot
be used for a vehicle towed from a residential or commercial property under a continuing contract to tow unauthorized vehicles.
PROVIDER’S INFORMATION
PROVIDER’S NAME (PRINT)
PROVIDER’S DRIVER’S LICENSE NUMBER
COMPANY NAME
COMPANY PHONE
COMPANY STREET ADDRESS
CITY
STATE
ZIP
q
q
IS THE VEHICLE BEING TRANSPORTED BY A TOW VEHICLE?
YES – ATTACH COPY OF REGISTRATION
NO
NAME OF PERSON AND OR COMPANY AUTHORIZING THE TOW: ________________________________________________________
VEHICLE OWNER INFORMATION
OWNER NAME (PRINT)
CO-OWNER NAME (PRINT)
VEHICLE INFORMATION
YEAR
MAKE
MODEL
BODY STYLE
COLOR
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE INFORMATION CERTIFICATION
Knowingly making a false statement on this form is punishable by a penalty not exceeding: $1,000, or 10 years imprisonment, or both.
Any willful misinformation provided with fraudulent intent may be prosecuted under Maryland law.
I solemnly affirm, under penalties of perjury, and upon personal knowledge, the contents of the foregoing paper are true to the best of my knowledge and/or
belief. I have the lawful right to possess the vehicle.
PRINTED NAME OF PROVIDER
SIGNATURE OF PROVIDER
DATE
NOTIFICATION CERTIFICATION
Any willful misinformation provided with fraudulent intent may be prosecuted under Maryland law.
I hereby certify, under penalties of perjury, that all required notifications to vehicle owner and lien holder (if applicable) have been made, pursuant to Maryland
law (TR 15-509 and 25-209), and documentation showing such notification is attached.
PRINTED NAME OF PERSON MAKING THE NOTIFICATION
DATE VEHICLE ACQUIRED
SIGNATURE OF PERSON CERTIFYING THE NOTIFICATION
AUTOMOTIVE DISMANTLER AND RECYCLER OR SCRAP PROCESSOR INFORMATION
COMPANY NAME (PRINT)
LICENSEE’S NAME
LICENSE NUMBER
STREET ADDRESS
CITY
STATE
ZIP
LOCATION WHERE VEHICLE IS BEING HELD (IF DIFFERENT FROM ABOVE)
In processing this vehicle, I affirm to the best of my knowledge and belief that I have complied with all applicable Federal and State laws.
PRINTED NAME
AUTHORIZED SIGNATURE
DATE
For more information, please call: 410-768-7000 (to speak with a customer service representative).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov