APPLICATION FOR SALVAGE CERTIFICATE OR NONREPAIRABLE VEHICLE CERTIFICATE Moricina. —_L) oupuicate ‘COMPLETE ONLY SECTION 1 OR SECTION 2 WITH SECTION 3 ‘SECTION 1 — SALVAGE CERTIFICATE uartey avi 2015 | 1HoHxN31FB613934 ca 3/20/2000 041940404-02 35, 633.00 2/4/2020 ‘The undersigned certifies that the above described vehicle, for which properly endorsed tiling documents are attached, isa totaloss ‘salvage, and requosts the Department of Motor Vehicles to issue a Salvage Certificate. NOTE: A Salvage Certificate cannot be issued for a stolen vehicle unless the vehicle has been recovered and determined to be a total loss (CVC 11515). ‘SECTION 2— NONREPAIRABLE VEHICLE CERTIFICATE ‘Avehicle declared nonrepairable may notbetitled or registered or use on theroads orhighways.ofCalifornia.A"nonrepairable ‘vehicle certificate" is a vehicle ownership document issued to the owner of a nonrepairable vehicle. Ownership of the vehicle may only be transferred two times on a nonrepairable vehicle certificate (CVC 432). ra HREERES BERT] BME BTLEN ERO Csurgica stip CiBumeauik Lower Declared (CVC 431) “The undersigned certifies that the above described vehicle, for which properly endorsed tiling documents are attached, is @ ‘nonropairable vehicle, and requests the Department of Motor Vohicies to issue a Nonrepairable Vehicle Certcat. x ‘SECTION 3 — CERTIFICATION OF LICENSE PLATE DISPOSITION ‘he license plates assigned to this vehicle: 1 Arebeing surrendered Plates surenderee: Clone C1 wo 1) Have been lost D) Have been destroyed (Occupational Licensees Only) Occupational License Number [Plate with owner Retained by owner for reassignment | certty (or dectare) under penalty of perjury under the laws ofthe State of California thet the foregoing is tue and correct. 2/12/2020 x‘A Public Service Agency PO. BOX 942869 ‘SACRAMENTO, CA 04269-0001 FOR OWNER RETAINING SALVAGE VEHICLE: ‘The Department of Motor Vehicles has been notified that you have retained your salvage vehicle following a total oss settlement wth your insurance company. You must apply for a salvage certificate and surrender the license plates assigned to the vehicle, within ten (10) days of the settlement of the loss. I this Vehicle is rebuilt and operated on the highway, it must be in safe mechanical condition. Before the vehicle Coan be retegistered, a vehicle identification number inspection, a brake certificate and a light adjustment cartficate willbe required. A $2 fee will also be collected to record salvage information on the vehicle record Future tiles and registration documents will how that this vehicle was “Salvaged” You should inform any potential purchaser of this fact FOR OWNER RETAINING NONREPAIRABLE VEHICLE: ‘The Department of Motor Vehicles has been notified that you have retained your nonrepairable vehicle following total lose satlement with your insurance company, You must apply for anonrepairable vehicle certificate and surrender the license plates assigned to the vehicle, within ten (10) days of the settlement of the loss. A vehicle declared nonrepairable may not be titled or registered for use on the roads or highways of California (CVC 11515.2)