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dmvnv.com 555 Wright Way Carson City, NV 89711-0700 (Department of Motor Vehicles )

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555 Wright Way
Carson City, NV 89711-0700
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
dmvnv.com
Signatures must be originals. Photocopies are not acceptable.
Alterations or Erasure VOIDS this Document
VP236 (Rev 07/2019)
INSURANCE COMPANY AFFIDAVIT WITHOUT ENDORSED TITLE
NRS 487.800
Please include a check or money order for the $11.00 Salvage Title fee, which includes a Technology fee, for the
Salvage Title. There is NO fee for a Non-Repairable Vehicle Certificate. Complete only when endorsed title has not
been received within 30 days after settlement. This form must be submitted with a completed Application for Salvage
Title or Non-Repairable Vehicle Certificate (VP-213), a completed VIN Inspection form (VP-15), and proof of mailings.
First mailing must be minimum of 30 days after settlement date.
Please type or print in blue or black ink
Vehicle Identification Number
Year
Make
Model
Insurance Company or Salvage Pool Name
Claim #
NV Business License Number
Mailing Address
Address
City
State
Zip Code
The settlement for the vehicle listed below was completed on
Date
Owner(s) did not supply certificate of title within 30 days of settlement. Attached is proof of the two attempts to contact
the owner(s), the application for salvage title or non-repairable vehicle certificate and the vehicle inspection certificate.
Registered Owner
First
Middle
Last
Address
City
State
Zip Code
Date
Date
Name (if no lienholder write “none”)
Address
City
State
Zip Code
Date
Mailing Address
The first mailing was sent on
The second mailing was sent on
Lienholder
Mailing Address
The first mailing was sent on
The second mailing was sent on
Date
I hereby certify and affirm that all provisions of NRS 487.800 have been complied with, and make this affidavit for the
purpose of satisfying the Nevada Department of Motor Vehicles that a Salvage Title or Non-Repairable Certificate for
the described vehicle should be issued in the name of the insurance company or salvage pool listed above upon the
facts stated herein. I also hereby release, discharge and agree to hold harm-less the Nevada Department of Motor
Vehicles of and from any and all liability to anyone whomsoever which may arise by reason of any contest of the validity
of this vehicle transfer. I declare under penalty of perjury that the foregoing is true and correct.
Authorized Representative Printed Name
Authorized Representative Signature
Date
-
-
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dmvnv.com 555 Wright Way Carson City, NV 89711-0700 (Department of Motor Vehicles )

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Completed 24 December 2020

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