Form REG480 "Non-repairable Vehicle Notice of Retention by Owner" - California

What Is Form REG480?

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

Form Details:

  • Released on November 1, 2003;
  • The latest edition provided by the California Department of Motor Vehicles;
  • 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 REG480 by clicking the link below or browse more documents and templates provided by the California Department of Motor Vehicles.

ADVERTISEMENT
ADVERTISEMENT

Download Form REG480 "Non-repairable Vehicle Notice of Retention by Owner" - California

349 times
Rate (4.8 / 5) 24 votes
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NON-REPAIRABLE VEHICLE
*
*
*
*
A Public Service Agency
NOTICE OF RETENTION BY OWNER
*
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
VEHICLE IDENTIFICATION NUMBER
MOTORCYCLE ENGINE NUMBER
MAKE
CALIFORNIA LICENSE PLATE
Vehicle Owner(s)
LAST NAME
FIRST
MIDDLE
as of the Date of Loss
LAST NAME
FIRST
MIDDLE
AND
OR
ADDRESS
CITY
STATE
ZIP CODE
Insurance Company
I, the undersigned, certify that the above described non-repairable vehicle has been retained by the owner(s)
and, as required by California Vehicle Code §11515.2, he/she has been notified that, within 10 days of the
Reporting Retention
settlement of loss date, he/she must surrender the vehicle’s Certificate of Title and license plates, and apply
of this Non-Repairable
for a Non-Repairable Vehicle Certificate. The vehicle owner(s) has also been notified that the Department of
Vehicle
Motor Vehicles’ database record for the vehicle will reflect a “Non-Repairable Vehicle” notation (brand).
DATE
AUTHORIZED SIGNATURE FOR INSURANCE COMPANY
PRINTED NAME
X
INSURANCE COMPANY NAME
INSURANCE COMPANY ADDRESS
DATE OF LOSS
CLAIM NUMBER
DAYTIME TELEPHONE NUMBER
(
)
MAIL COMPLETED FORM TO: Department of Motor Vehicles, P.O. Box 932345, Sacramento, CA 94232-3450
REG 480 (REV. 11/2003) WWW
Clear Form
Print
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NON-REPAIRABLE VEHICLE
*
*
*
*
A Public Service Agency
NOTICE OF RETENTION BY OWNER
*
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
VEHICLE IDENTIFICATION NUMBER
MOTORCYCLE ENGINE NUMBER
MAKE
CALIFORNIA LICENSE PLATE
Vehicle Owner(s)
LAST NAME
FIRST
MIDDLE
as of the Date of Loss
LAST NAME
FIRST
MIDDLE
AND
OR
ADDRESS
CITY
STATE
ZIP CODE
Insurance Company
I, the undersigned, certify that the above described non-repairable vehicle has been retained by the owner(s)
and, as required by California Vehicle Code §11515.2, he/she has been notified that, within 10 days of the
Reporting Retention
settlement of loss date, he/she must surrender the vehicle’s Certificate of Title and license plates, and apply
of this Non-Repairable
for a Non-Repairable Vehicle Certificate. The vehicle owner(s) has also been notified that the Department of
Vehicle
Motor Vehicles’ database record for the vehicle will reflect a “Non-Repairable Vehicle” notation (brand).
DATE
AUTHORIZED SIGNATURE FOR INSURANCE COMPANY
PRINTED NAME
X
INSURANCE COMPANY NAME
INSURANCE COMPANY ADDRESS
DATE OF LOSS
CLAIM NUMBER
DAYTIME TELEPHONE NUMBER
(
)
MAIL COMPLETED FORM TO: Department of Motor Vehicles, P.O. Box 932345, Sacramento, CA 94232-3450
REG 480 (REV. 11/2003) WWW
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NON-REPAIRABLE VEHICLE
*
*
*
*
A Public Service Agency
NOTICE OF RETENTION BY OWNER
*
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
VEHICLE IDENTIFICATION NUMBER
MOTORCYCLE ENGINE NUMBER
MAKE
CALIFORNIA LICENSE PLATE
Vehicle Owner(s)
LAST NAME
FIRST
MIDDLE
as of the Date of Loss
LAST NAME
FIRST
MIDDLE
AND
OR
ADDRESS
CITY
STATE
ZIP CODE
Insurance Company
I, the undersigned, certify that the above described non-repairable vehicle has been retained by the owner(s)
and, as required by California Vehicle Code §11515.2, he/she has been notified that, within 10 days of the
Reporting Retention
settlement of loss date, he/she must surrender the vehicle’s Certificate of Title and license plates, and apply
of this Non-Repairable
for a Non-Repairable Vehicle Certificate. The vehicle owner(s) has also been notified that the Department of
Vehicle
Motor Vehicles’ database record for the vehicle will reflect a “Non-Repairable Vehicle” notation (brand).
DATE
AUTHORIZED SIGNATURE FOR INSURANCE COMPANY
PRINTED NAME
X
INSURANCE COMPANY NAME
INSURANCE COMPANY ADDRESS
DATE OF LOSS
CLAIM NUMBER
DAYTIME TELEPHONE NUMBER
(
)
MAIL COMPLETED FORM TO: Department of Motor Vehicles, P.O. Box 932345, Sacramento, CA 94232-3450
REG 480 (REV. 11/2003) WWW
Clear Form
Print
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NON-REPAIRABLE VEHICLE
*
*
*
*
A Public Service Agency
NOTICE OF RETENTION BY OWNER
*
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
VEHICLE IDENTIFICATION NUMBER
MOTORCYCLE ENGINE NUMBER
MAKE
CALIFORNIA LICENSE PLATE
Vehicle Owner(s)
LAST NAME
FIRST
MIDDLE
as of the Date of Loss
LAST NAME
FIRST
MIDDLE
AND
OR
ADDRESS
CITY
STATE
ZIP CODE
Insurance Company
I, the undersigned, certify that the above described non-repairable vehicle has been retained by the owner(s)
and, as required by California Vehicle Code §11515.2, he/she has been notified that, within 10 days of the
Reporting Retention
settlement of loss date, he/she must surrender the vehicle’s Certificate of Title and license plates, and apply
of this Non-Repairable
for a Non-Repairable Vehicle Certificate. The vehicle owner(s) has also been notified that the Department of
Vehicle
Motor Vehicles’ database record for the vehicle will reflect a “Non-Repairable Vehicle” notation (brand).
DATE
AUTHORIZED SIGNATURE FOR INSURANCE COMPANY
PRINTED NAME
X
INSURANCE COMPANY NAME
INSURANCE COMPANY ADDRESS
DATE OF LOSS
CLAIM NUMBER
DAYTIME TELEPHONE NUMBER
(
)
MAIL COMPLETED FORM TO: Department of Motor Vehicles, P.O. Box 932345, Sacramento, CA 94232-3450
REG 480 (REV. 11/2003) WWW