New York State Department of Motor Vehicles FOR OFFICIAL USE ONLY APPLICATION FOR SALVAGE VEHICLE EXAMINATION www.dmv.ny.gov INSTRUCTIONS File Number So the Department of Motor Vehicles can process your request for a vehicle examination, you must: 1. Send the following forms with this application: Inspection Information a) ORIGINAL MV-907A, Salvage Certificate or ORIGINAL proofs of ownership; Inspection Station Facility Number b)ORIGINAL MV-82TON, Application for Title; c) ORIGINAL MV-901, Notice of Recorded Lien (if necessary); Certificate of Inspection Number d)ORIGINAL MV-50, Retail Certificate of Sale (if applicable); e) FS-6T, available at any Motor Vehicles office, showing that you paid sales tax. f) Proof of identity: Individuals: a photocopy of your NYS Driver License or Non-Driver ID card that is current or expired less than 2 years, or copies of proof of date of birth and 6 points of proof of name, as listed on DMV form ID-82 (Proofs of Identity for Registration and Title). Corporations: a certified copy of your Certificate of Incorporation, or a NYS vehicle registration or title in the same corporate name, or a NYS Department of State filing receipt with DBA, or a certificate of good standing, subsisting, or foreign bid issued by NYS DOS. Partnerships: your Certificate of Partnership, or DBA filing receipt from your County Clerk, or Statement of Partnership or Joint Ownership (MV-83T). If you need a five-day Temporary Motor Vehicle Transport Permit to legally drive your vehicle to the exam, YOU MUST submit the following with your application: g)Proof of NYS Safety Inspection (have the inspector write the inspection information in the box above); h)Proof of NYS Insurance coverage (the original FS-20 or FS-21 - not a copy), which will be returned to you along with your Temporary Permit. 2. Enclose a check or money order for $200 ($150 for the examination, plus $50 for the title processing fee). If anything other than an MV-907A is submitted as proof of ownership, an additional $5 fee is required. Make the check payable to “Commissioner of Motor Vehicles.” Write the vehicle year, make and complete Vehicle Identification Number and your Facility Number (if applicable) on the check or money order. This fee cannot be refunded. No third-party checks or starter checks will be accepted. 3. Mail the application and supporting documents to: Auto Theft & Salvage, DFI, PO Box 2105 - Empire State Plaza, Albany, New York 12220-0105. If you do not provide the proper forms, fees and signatures, your application and check or money order will be returned to you. OWNER INFORMATION Owner’s Name (Use Corporate Name, if applicable) o DEALER o INDIVIDUAL Home Telephone No. Business Telephone No. ( ( o VEHICLE REBUILDER ) o DISMANTLER E-mail Address ) Owner’s Address (Number and Street) Apt. # City State ZIP Code Apt. # Owner’s Legal Address (if different) City ZIP Code State ALTERNATE ADDRESS (If you want the examination notice sent to another address, please complete the following): Name (Use Corporate Name, if applicable) Home Telephone No. Business Telephone No. ( ( ) E-mail Address ) Address (Number and Street) Apt. # City State ZIP Code APPOINTMENT SITES: I request that the vehicle be examined at the following location (indicate first, second and third choice): __ Buffalo __ Rochester __ Horseheads* __ Syracuse __ Binghamton* __ Highland __ Utica __ Canton* __ Norwich* __ Albany __ Plattsburgh* __ Elmsford (serves Putnam/Westchester/Rockland & 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. PAGE 2 OF THIS FORM MUST BE COMPLETED AND SIGNED *MV-899* MV-899 (4/11) PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com VEHICLE INFORMATION Vehicle Identification Number Year Vehicle Body Type (check all applicable boxes): o 2 Door o 4 Door o Passenger o Motorcycle o Trailer o Tractor o Stretch Limousine o Hatchback Make Model o Suburban o Pickup Color o Other ________________ ODOMETER DISCLOSURE STATEMENT: Federal and state laws require that you state the mileage of the vehicle described above when transferring ownership. Failure to do so, or providing a false statement, may result in fines and/or imprisonment. I certify that, to the best of my knowledge, the odometer reading is _______________________ miles, and that this reading reflects the actual (no tenths) mileage of the vehicle described, or that (check if applicable): o o I certify that, to the best of my knowledge, the above disclosed odometer reading “EXCEEDS MECHANICAL LIMITS.” I certify that, to the best of my knowledge, the above disclosed odometer reading is “NOT THE ACTUAL MILEAGE. WARNING: ODOMETER DISCREPANCY.” If any major component part has been replaced, you MUST present sales receipts at the time of the vehicle examination. The receipts must show the stock number and the vehicle identification number of any replacement parts used for the vehicle. MAJOR COMPONENT PART OR PARTS REPLACED (check all boxes that apply to your vehicle): o o o o Left 3/4 Nose Right 3/4 Nose Nose (Complete) Body o o o o Rear Clip Cowls Front Cut Off Frame (Repair or Replacement) o o o Vehicle Identification Number Plate Missing, Altered or Defaced Engine Transmission o o o Driver Air Bag Passenger Air Bag Other Air Bags TYPE OF SALVAGE (check all boxes that apply to your vehicle): o o o o o Recovered Stolen With No Damage ______________________________________________________________________________ Recovered Stolen (indicate damage) ____________________________________________________________________________ Collision Loss (indicate damage) ______________________________________________________________________________ Flood Damage (indicate damage) ______________________________________________________________________________ Other (give details) ________________________________________________________________________________ The Division of Field Investigation will notify you by mail of the date, time and address of your appointment. If you are unable to keep a scheduled appointment, please call the Field Investigation Scheduling Unit at (518) 486-6560 at least two business days (48 hours) before your scheduled appointment.You can also cancel by sending an e-mail to DFICancel@dmv.ny.gov. If you don’t keep a scheduled appointment, your fee will be forfeited. The owner must then apply for another examination by completing a new MV-899 and paying a new fee of $150. FAILURE TO COMPLETE THE ABOVE SECTION ACCURATELY AND TRUTHFULLY, OR TO SIGN BELOW, WILL DELAY AND MAY PRECLUDE THE ISSUANCE OF A TITLE FOR THIS VEHICLE. CERTIFICATION: I certify that, to the best of my knowledge, the information provided on this form is true and complete. - Print Name: __________________________________________ Signature: MV-899 (4/11) - ___________________________________________ DMV Facility Number (if applicable) _____________________ Date __________________________ (Sign Name in Full) ANY FALSE STATEMENT IS A MISDEMEANOR PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com