Fillable SALVAGE EXAMINATION/TITLE APPLICATION (New York State)

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SALVAGE EXAMINATION/TITLE APPLICATION (New York State)

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  • 14 check-boxes
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File type: PDF

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Is this a corporation or partnership?
o Yes o No
M F
o o
Year Make
Color
Unladen Weight
Cylinders
Area Code
( )
Maximum Gross Weight
NAME OF PRIMARY OWNER (Last, First, Middle)
NYS driver license number of PRIMARY
SEX
THE ADDRESS WHERE PRIMARY OWNER GETS MAIL
For trailers & commercial vehicles
For commercial vehicles
For rentals,buses & taxis
VEHICLE DESCRIPTION
Body Type For Cars (mark one)
Body Type For Other Vehicles (mark one)
Type of Power (Fuel)
VEHICLE IDENTIFICATION NUMBER
Odometer Disclosure/Reading in Miles
CONTACT TELEPHONE # (Required)
Month Day Year
DATE OF BIRTH
Month Day Year
Axles
Distance
Lienholder Name and
Mailing Address
Lien Filing Code
(Assigned
by DMV)
Apt. No. City or Town State Zip Code County of Residence
Apt. No. City or Town State Zip Code
SALVAGE EXAMINATION/TITLE APPLICATION
For more information about salvage, visit dmv.ny.gov
THE ADDRESS WHERE PRIMARY OWNER RESIDES IF DIFFERENT FROM THE MAILING ADDRESS.
(DO NOT GIVE A P.O. BOX.)
(Include Street Number and Name, Rural Delivery or box number. This address will be on the document.)
PAGE 1 OF 2
MV-83SAL (9/20)
NY
DEALER
ONLY
Seating Capacity
Station Wagon or
o 2-Door o 4-Door o Convertible o Suburban oOther
o oVan oMotorcycle o oTrailer oOther
M F
o o
NAME OF CO-OWNER (Last, First, Middle)
NYS driver license number of CO-OWNER
SEX
DATE OF BIRTH
Pick-up
Truck
Tow
Truck
Your current proof of ownership determines the total fee you must pay:
A. New York State title/Out-of-state title/Marshal’s sale/Police Bill of Sale/Garageman Lien: $205.00
B. New York State Salvage Certificate (form MV-907A):
$200.00
C. Owner-retained Salvage:
$200.00
D. You received a letter from the Department of Motor Vehicles that indicates your vehicle must go through the salvage
examination process (DMV Case # ): Include the fee indicated in the letter.
Make your check or money order payable to “Commissioner of Motor Vehicles”.
NOTE: These fees cannot be refunded. The Department of Motor Vehicles does not accept third party or starter checks.
If you do not provide the correct forms, fees, and a completed and signed application,
DMV must return your application and check or money order to you.
City
State ZIP Code
Apt. #
Business Telephone No.
( )
*
Email Address
(Please print clearly)
EMAIL AND ALTERNATE ADDRESS (If you want the examination notice sent to another address, or by email, please complete the following):
Name (Use Corporate
Name, if applicable)
Address (Number
and Street)
Home Telephone No.
( )
APPOINTMENT SITES: I request to have the vehicle examined at the following location:
__ Buffalo
__ Rochester
__ Horseheads**
__ Syracuse
__ Binghamton**
__ Highland (
serves Ulster/
Putnam/Dutchess/Orange &
Rockland Counties
__ Utica
__ Canton**
__ Oxford**
__ Albany
__ Plattsburgh**
__ Bronx
(serves Westchester & Bronx counties)
__ Queens Village (serves New York/Queens/
Kings & Richmond counties)
__ West Babylon (serves Nassau & Suffolk counties)
**NOTE:
Only occasional service is offered at this location.
Do you need a permit to drive the vehicle to/from the exam location? (NYS residents only)
o Yes o No
If yes, you must include the following: l current proof of NYS insurance (a copy of form FS-20 or form FS-21)
l NYS Safety/Emissions Inspection report showing “passed”
I certify that the odometer reading of is o Actual, o Not Actual, or o Exceeds mechanical limits.
*
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.
o Gas o Diesel o Electric o Flex
o CNG o Propane o Hybrid o None
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.
DMV Facility
Number (if applicable)
Dealer
Signature
(if applicable)
MV-83SAL (9/20)
PAGE 2 OF 2
CHECKLIST TO AVOID REJECTION OF APPLICATION: (Please make sure all required forms are properly completed and signed)
X
(Sign Name in Full)
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 your scheduled appointment, you will forfeit your fee. You must pay a new fee of
$150.00. To pay this fee, send a check or money order to the address above, or call either 518-486-9786 or 1-800-698-2931 to pay by credit card.
o o Vehicle Identification
Number Plate Missing,
Altered or Defaced
o o Left 3/4 Nose
o o Rear Clip
o o Cowls
o o Front Cut Off
YES NO
o o Right 3/4 Nose
o o Nose (Complete)
o o Body
YES NO
YES NO
YES NO
o o Frame (Repair or
Replacement)
o o Engine
o o Transmission
YES NO
o o Driver Air Bag
o o Passenger Air Bag
o o Other Air Bags
YES NO
TYPE OF SALVAGE (check all boxes that apply to your vehicle):
o Recovered Stolen With No Damage o Recovered Stolen (with damage) o Collision Loss o Flood Damage
o Unknown o Other (explain)
o Not required for Bikes, trailers, etc.
MAJOR BODY PARTS, POWER TRAIN, AND AIRBAGS REPLACED (you must check either Yes or No for each item):
ITEMIZED BODY REPAIR (you must check either Yes or No for each item):
If you have questions about your application regarding:
l Examination Scheduling, call: (518) 474-0955 Monday - Friday 9:00am - 4:00pm
l Application and Title, call: (518) 473-0399 Tuesday - Wednesday 9:00am - 4:00pm
Mail your completed application and fee to:
AUTO THEFT & SALVAGE UNIT
DFI P.O. Box 2105 Empire State Plaza
Albany NY 12220-0105
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
Individuals - NY residents: a copy of your current NYS driver license or NYS
non-driver ID card. Non-Residents: 6 points of ID (refer to form ID-82).
Corporations - A copy of your Certificate of Incorporation, or a NYS vehicle
registration or title in the corporation’s name, or a NYS Department of State
(DOS) filing receipt, or assumed name (DBA), or a certificate of good standing.
Partnerships - Your Certificate of Partnership or DBA filing receipt from your
County Clerk, or Statement of Partnership or Joint Ownership (form MV-83T).
o Signed MV-83SAL
o Original Proof of Ownership
*
Once approved, original documents cannot be returned.
o Check or Money Order with correct fee
o Original Bill of Sale and/or Dealer Reassignment (if applicable)
*
o Proof of Sales Tax Paid (form FS-6T or form MV-50)
o Proof of Identity (as listed below):
o Original Lien or Lien Release (if applicable)
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.
*
Must have both buyer and seller signatures
Co-Owner
Print Name:
Signature
Date:
X
(Sign Name in Full)
Primary Owner
Print Name:
Signature
X
1. BUMPER/GRILL
16. RIGHT FRONT
FENDER
15. RIGHT FRONT
DOOR
14. RIGHT CENTER 13. RIGHT REAR
PILLAR DOOR 12. ROOF
11. RIGHT REAR
1/4 PANEL
10. TRUNK LID
9 REAR BUMPER
8. LEFT REAR
1/4 PANEL
7. LEFT REAR
DOOR
6. LEFT CENTER
PILLAR
5, LEFT FRONT
DOOR
4. LEFT FRONT
FENDER
3. HOOD
2. RADIATOR SUPPORT
17. FRAME
NAME OF PRIMARY OWNER (Last, First, Middle)
RESET/CLEAR
RESET/CLEAR
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SALVAGE EXAMINATIONTITLE APPLICATION (New York State)

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Completed 7 May 2021

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