Alabama Application for Salvage Certificate of Title

Application for Salvage Certificate of Title
MVT 41-1 (2-21).qxp
ALABAMA DEPARTMENT OF REVENUE
MOTOR VEHICLE DIVISION

MVT 41-1
Doc Code MVT51C
2/21

P.O. Box 327640 • Montgomery, AL 36132-7640
www.revenue.alabama.gov

Application For Salvage Certificate of Title

This application may be used by an individual or company to report a vehicle as being salvage. The outstanding properly assigned certificate of title must be
submitted along with this application for processing. 
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TRANS
CODE

VEHICLE IDENTIFICATION NUMBER

CYLS

DATE OF PURCHASE

NUMBER
LIENS

NAME(S)  (Last Name, First, Middle) _____________________________________________________

10

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COLOR

ODOMETER READING

FELONY OFFENSE FOR FALSE ADDRESS

CURRENT MAILING ADDRESS ____________________________________________________________________________________________________
CITY______________________________________________________________________________ STATE _______________ ZIP ___________________

YEAR
MODEL

MAKE

MODEL

CURRENT ALABAMA TITLE NO.

APPLICANT SHALL DISCLOSE ODOMETER READING (check one)

6 ACTUAL MILEAGE
6 EXCEEDS MECHANICAL LIMITS
6 NOT ACTUAL MILEAGE — WARNING, ODOMETER DISCREPANCY
DEPARTMENT USE ONLY

(DO NOT ENTER IF LIEN RELEASED)

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NAME ______________________________________________________________________________________ LIEN DATE _________________________

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ADDRESS _______________________________________________________________________________________________________________________
CITY______________________________________________________________________________ STATE ______________ ZIP ____________________

FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
(DO NOT ENTER IF LIEN RELEASED)

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NAME ______________________________________________________________________________________ LIEN DATE _________________________
ADDRESS _______________________________________________________________________________________________________________________
CITY______________________________________________________________________________ STATE ______________ ZIP ____________________

FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD
OWNER(S) AUTHORIZATION FOR SPECIAL MAILING
I, WE, HEREBY AUTHORIZE MY SALVAGE CERTIFICATE OF TITLE TO BE MAILED TO (IF NO LIENS LISTED HEREON):
NAME _________________________________________________________________________________________________________________________________
ADDRESS ______________________________________________________________________________________________________________________________
CITY____________________________________________________________________________________ STATE ________________ ZIP ____________________

A

__________ day of __________________________, _________.
_____________________________________________________________________________________________________

In accordance with Section 32-8-87, Code of Alabama 1975, the motor vehicle described above was determined to be a salvage vehicle on the
CITY/STATE WHERE TOTAL LOSS OCCURRED

CHECK THE BLOCK IF TOTAL LOSS WAS DUE IN PART TO WATER DAMAGE

6

CHECK THE BLOCK ONLY IF THE VEHICLE IS JUNK OR TO BE SOLD FOR PARTS ONLY

**

***If the loss occurred outside of Alabama, the applicant must comply with salvage laws in the state where the loss occurred.***

** 6

A VEHICLE THAT IS JUNK OR SOLD FOR PARTS ONLY CAN NOT BE REBUILT OR RETITLED IN ALABAMA.

I, THE UNDERSIGNED, CERTIFY THAT THE VEHICLE DESCRIBED ABOVE IS OWNED BY ME AND I HEREBY MAKE APPLICATION FOR A SALVAGE CERTIFICATE OF TITLE FOR SAID MOTOR VEHICLE AND THIS VEHICLE WILL NOT BE THE
SUBJECT OF LIEN PRIOR TO RECEIPT OF TITLE UNLESS INDICATED ABOVE, I FURTHER CERTIFY THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
OWNER’S SIGNATURE(S)

________________________________________________________________________________________________________________
DATE

B
NAME AND ADDRESS OF INSURANCE CO. AND ADJUSTING CO. (IF ANY)
NAME OF COMPANY ___________________________________________________________________________________

NAME OF COMPANY ___________________________________________________________________________________

STREET ADDRESS ____________________________________________________________________________________

STREET ADDRESS ____________________________________________________________________________________

CITY ________________________________________________________ STATE __________ ZIP __________________

CITY ________________________________________________________ STATE __________ ZIP __________________

ADJUSTER’S NAME (TYPE OR PRINT) ___________________________________________________________________

ADJUSTER’S NAME (TYPE OR PRINT) ___________________________________________________________________

TELEPHONE NUMBER _________________________________________________________________________________
INSURANCE COMPANY CLAIM OR POLICY NUMBER

_________________________________

TELEPHONE NUMBER _________________________________________________________________________________
CHECK THE BLOCK IF TOTAL LOSS WAS DUE IN PART TO WATER DAMAGE

6

CHECK THE BLOCK ONLY IF THE VEHICLE IS JUNK OR TO BE SOLD FOR PARTS ONLY

**

** 6

A VEHICLE THAT IS JUNK OR SOLD FOR PARTS ONLY CAN NOT BE REBUILT OR RETITLED IN ALABAMA.

I, THE UNDERSIGNED, CERTIFY THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT

6 THE VEHICLE DESCRIBED ABOVE WAS DECLARED A TOTAL LOSS, COMPENSATION PAID THE OWNER BY THE ABOVE NAMED INSURANCE COMPANY AND SAID INSURANCE COMPANY HEREBY MAKES APPLICATION FOR A SALVAGE
CERTIFICATE OF TITLE. THE OUTSTANDING CERTIFICATE OF TITLE, PROPERLY ASSIGNED, IS ATTACHED HERETO.

6 THE OWNER WISHES TO RETAIN THE SALVAGE ON MENTIONED VEHICLE.
DATE

________________________________

INSURANCE COMPANY’S
REPRESENTATIVE SIGNATURE

________________________________________
CITY/STATE WHERE TOTAL LOSS OCCURRED: ______________________________________
DATE VEHICLE DECLARED A TOTAL LOSS:

________________________________________________________________________

Submit $15.00 Application Fee in certified funds (non-refundable) payable to the Alabama Department of Revenue.