Form MV-6 "Application for Nonrepairable or Salvage Certificate" - Pennsylvania

What Is Form MV-6?

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

Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the Pennsylvania 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 MV-6 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Transportation.

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Download Form MV-6 "Application for Nonrepairable or Salvage Certificate" - Pennsylvania

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MV-6 (7-19)
APPLICATION FOR NONREPAIRABLE
www dmv pa gov
OR SALVAGE CERTIFICATE
For Department Use Only
See Instructions on Reverse
Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104
NOTE: Insurance companies should not use this form and must complete Form MV-6IS or Form MV-6SV if applying for a certificate of salvage.
1.
Original Certificate of Salvage
2.
Duplicate Certificate of Salvage
3.
Original Nonrepairable Certificate
q
q
q
Check here
if vehicle is a total loss due to flood (salvage certificate will be branded with a “W”).
q
Check here
if vehicle is a total loss due to theft (salvage certificate will be branded with an “N”). NOTE: Section E must be completed if no police incident
q
report is attached.
A APPLICANT INFORMATION
Last Name (or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Co-Owner Last Name
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
Street Address
City
State
Zip Code
B VEHICLE DESCRIPTION
Title Number
Vehicle Identification Number
Year
Make
Owner’s Name as Printed on Face of Attached Title (Only for original certificate of salvage request.)
NO TENTHS
I/We certify to the best of my/our knowledge that the odometer reading is ____ ____ ____ , ____ ____ ____
miles and reflects the actual mileage of the vehicle,
unless one of the following boxes is checked:
Reflects the amount of mileage in excess of mechanical limits.
Is NOT the actual mileage. WARNING: Odometer discrepancy.
WARNING: Federal and state laws require that you state the mileage in connection with this application. Failure to complete or providing a false statement may result in fines
and/or imprisonment.
C VEHICLE IDENTIFICATION NUMBER & WEIGHT VERIFICATION
NOTE: If an out-of-state certificate of title is attached to this application, a tracing of the Vehicle Identification Number (VIN) must be affixed in the space
provided. If a tracing cannot be obtained, the VIN must be listed and verified by a certified inspection mechanic or authorized agent in the
appropriate spaces below.
List VIN or Tape
VIN Tracing Here
Unladen Weight (Empty)
Gross Vehicle Weight Rating
Authorized Agent or Certified Inspection Mechanic (Print Name)
Dealer/Business Partner/Mechanic ID#
I certify that I have verified that a legible tracing cannot be
Authorized Agent or Certified Inspection Mechanic Sign Here
secured and that the above VIN and vehicle weight information
listed in Section C is correct.
D APPLICATION FOR DUPLICATE
REASON:
Lost
Stolen
Defaced (Certificate must be attached)
Never Received
*Other
* Please Explain: __________________________________________________________________________________________________________
LAW ENFORCEMENT REPORTING - To be completed by the applicant when applying for an original certificate of salvage and no police
E
report is attached.
Check (4) One: REPORTED TO:
Local Law Enforcement
State Law Enforcement
Incident Number
Date of Incident
Law Enforcement Station Name
Law Enforcement Telephone Number
Law Enforcement Station Address
Vehicle Recovery Date (If applicable)
Nature of Incident
Investigator
Badge Number
F
SIGNATURES
I/We hereby certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I/we understand that any misstatement of fact is a misdemeanor of the third degree punish-
able by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).
______________________________________________________________________________________________
_________________________________________
Signature of Applicant or Authorized Person
Telephone Number
______________________________________________________________________________________________
_________________________________________
Signature of Co-Applicant
Date
MV-6 (7-19)
APPLICATION FOR NONREPAIRABLE
www dmv pa gov
OR SALVAGE CERTIFICATE
For Department Use Only
See Instructions on Reverse
Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104
NOTE: Insurance companies should not use this form and must complete Form MV-6IS or Form MV-6SV if applying for a certificate of salvage.
1.
Original Certificate of Salvage
2.
Duplicate Certificate of Salvage
3.
Original Nonrepairable Certificate
q
q
q
Check here
if vehicle is a total loss due to flood (salvage certificate will be branded with a “W”).
q
Check here
if vehicle is a total loss due to theft (salvage certificate will be branded with an “N”). NOTE: Section E must be completed if no police incident
q
report is attached.
A APPLICANT INFORMATION
Last Name (or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Co-Owner Last Name
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
Street Address
City
State
Zip Code
B VEHICLE DESCRIPTION
Title Number
Vehicle Identification Number
Year
Make
Owner’s Name as Printed on Face of Attached Title (Only for original certificate of salvage request.)
NO TENTHS
I/We certify to the best of my/our knowledge that the odometer reading is ____ ____ ____ , ____ ____ ____
miles and reflects the actual mileage of the vehicle,
unless one of the following boxes is checked:
Reflects the amount of mileage in excess of mechanical limits.
Is NOT the actual mileage. WARNING: Odometer discrepancy.
WARNING: Federal and state laws require that you state the mileage in connection with this application. Failure to complete or providing a false statement may result in fines
and/or imprisonment.
C VEHICLE IDENTIFICATION NUMBER & WEIGHT VERIFICATION
NOTE: If an out-of-state certificate of title is attached to this application, a tracing of the Vehicle Identification Number (VIN) must be affixed in the space
provided. If a tracing cannot be obtained, the VIN must be listed and verified by a certified inspection mechanic or authorized agent in the
appropriate spaces below.
List VIN or Tape
VIN Tracing Here
Unladen Weight (Empty)
Gross Vehicle Weight Rating
Authorized Agent or Certified Inspection Mechanic (Print Name)
Dealer/Business Partner/Mechanic ID#
I certify that I have verified that a legible tracing cannot be
Authorized Agent or Certified Inspection Mechanic Sign Here
secured and that the above VIN and vehicle weight information
listed in Section C is correct.
D APPLICATION FOR DUPLICATE
REASON:
Lost
Stolen
Defaced (Certificate must be attached)
Never Received
*Other
* Please Explain: __________________________________________________________________________________________________________
LAW ENFORCEMENT REPORTING - To be completed by the applicant when applying for an original certificate of salvage and no police
E
report is attached.
Check (4) One: REPORTED TO:
Local Law Enforcement
State Law Enforcement
Incident Number
Date of Incident
Law Enforcement Station Name
Law Enforcement Telephone Number
Law Enforcement Station Address
Vehicle Recovery Date (If applicable)
Nature of Incident
Investigator
Badge Number
F
SIGNATURES
I/We hereby certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I/we understand that any misstatement of fact is a misdemeanor of the third degree punish-
able by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).
______________________________________________________________________________________________
_________________________________________
Signature of Applicant or Authorized Person
Telephone Number
______________________________________________________________________________________________
_________________________________________
Signature of Co-Applicant
Date
INSTRUCTIONS
If Block 1 is checked: Complete Sections A, B, C (if applicable), E (if applicable) and F.
l
The applicant completing this application must be either the owner whose name appears on the face
of the attached certificate of title, or if the title is assigned, the last assignee whose name appears on
the reverse side of the certificate of title. NOTE: Individuals should list their PA Driver’s License (PA
DL) or Photo ID# in the space provided. Businesses should list their Business ID# (Bus. ID#) where
indicated (i.e. - E.I.N.). NOTE: If the certificate of title is assigned to an individual, the signatures in the
assignment must be notarized.
The certificate of title currently in the name of (or assigned to) the applicant must accompany this
application.
If an out-of-state title is attached, Section C must be completed and a tracing of the VIN must be
attached. If the VIN tracing cannot be obtained, the VIN must be listed and verified by a certified
inspection mechanic OR an authorized notary public employed by a full agent or a motor vehicle
dealer. If the vehicle is a truck, truck tractor, trailer or motor home, weight information must also be
listed and verified.
If an out-of-state title is attached and the title is assigned to a PA dealer OR the title is assigned to an
individual with a PA residence, then no fee is required.
If an out-of-state title is attached and the title is assigned to an individual with a PA residence who
is also reassigning it to another individual with a PA residence, a title fee of $55 must accompany
this application.
If the vehicle is a total loss due to flood, please check the appropriate block. A salvage certificate will
be issued with a “W” brand.
If the vehicle is a total loss due to theft, please check the appropriate block. A salvage certificate will
be issued with an “N” brand. If no police incident report is attached, Section E must be completed.
If the vehicle was recovered prior to the submission of this form, the vehicle recovery date must be
listed in Section E.
If Block 2 is checked: Complete Sections A, B, D and F.
l
When a certificate of salvage has been lost, stolen, defaced, or never received, the owner listed on
the front of the original certificate may obtain a duplicate. No fee is required.
If Block 3 is checked: Complete Sections A, B, C and F.
l
When a nonrepairable certificate is issued, the vehicle may ONLY be used as a source for parts or
scrap and may NOT be issued a certificate of title or a salvage certificate.
Visit us at www.dmv.pa.gov or call us at 717-412-5300. TTY callers — please dial 711 to reach us.
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