Form Mv-1s - Application For An Original Or Replacement 'Salvage' Title

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MV-1S Revised 03-2013

Application for an Original or Replacement ‘Salvage’ Title ‘Only’

Original Title Fee $18.00 - Replacement Title Fee $8.00 - State Title Ad Valorem T ax ( S TAVT) - Fair Market Value (FMV) ________________

FMV x 1% = STAVT _____________________

Pay with check or money order made payable to the Department of Revenue.

All applicable spaces on this form must be completed without alterations. This application must be typed, electronically completed and printed

or printed legibly by-hand in blue or black ink and signed by the vehicle owner(s ). If the title when issued is to be mailed to an appointed

attorney -in-fact, complete the “Mail To” Section and attach the original power of attorney authorizing the mailing.

Replacement

Check the box indicating type of application:

Original

Vehicle Section

Vehicle Identification Number

Vehicle Year

Make

Type of Body

Vehicle Color

Model Name or Number

No. of Cylinders

Date Purchased

Fuel Type

New or Used

Current Title #

State of Issue

Odometer Reading (Do Not Include Tenths)

The odometer reading reflects the total actual miles the vehicle has traveled unless you check one of the following

boxes:

EXEMPT - Vehicle exempt from odometer disclosure requirements.

Exceeds the Mechanical Limits of the Odometer

Warning: Odometer Discrepancy

Not the Actual Mileage,

Owner Section

Number of Owners__________

Owner #1

Full Legal Name of Owner #1

Date of Birth

Driver’s License # (If

State/Country of

First

Middle

Last

Suffix

Individual)

Issue

Purchaser’s GA Sales Tax #

(when applicable)

Business Name

Leasing Company Name

If you purchased this vehicle from an out-of-

state dealer/business, did you pick-up the

vehicle out-of-state?

Yes

Full Legal Name of Owner #2

Date of Birth

Owner #2

Driver’s License # (If

State/Country of

First

Middle

Last

Suffix

Individual)

Issue

Business Name

Leasing Company Name

Street Address

Mailing Address

(if different from street address)

City

State

Zip

City

State

Zip

Lien or Security Interest Section

Number of Liens or Security Interests:_______

If you are an ELT (Electronic Lien Title) Participant, please check the following box(es)

Lien

Security Interest Holder’s/Lien Holder’s or ELT 12 Digit Customer ID#

Security Interest Holder’s/Lien Holder’s Name

Security Interest Holder’s/Lien Holder’s Name & Address

Address

City

State

Zip

City

State

Zip

“Mail To” Section

Seller Section

Full Legal Name or Business Name

e l

s ’ r

B /

s ’

g i

t i

s u

o t

r e

e l l

s ’ r

l a

s e

x a

Full Legal Name or Business Name

Address

City

State

Zip

City

State

Zip

Warning: Any owner of a salvage motor vehicle who transfers or attempts to transfer a salvage vehicle without first obtaining a salvage certificate of title shall be

guilty of a misdemeanor of a high and aggravated nature, punishable by a fine not to exceed $5,000. You cannot dispose or sell this “Salvage” vehicle until you have

first obtained a “Salvage” certificate of title in your name.

I do solemnly swear under criminal penalty of a felony for fraudulent use of a false or fictitious name or address or for making a material false statement punishable by

a fine up to $5,000 or by imprisonment of up to five-years or both that the statements contained herein are true and accurate.

#1 Owner’s Signature:

Date:

#2 Owner’s Signature:

Date:

SALVAGE

Application for a Salvage Title must be made prior to a “Total Loss” Claim Being Paid