Bay Auto Forms - page 13

New York State Department of Motor Vehicles
STATEMENT OF VEHICLE OWNER WHO DOES NOT HAVE A VALID TITLE
PAGE 1 OF 2
I certify that I am the owner of the vehicle described below and that: (1) I purchased the vehicle from the titled owner and I never titled the
vehicle in my own name; or (2) I was issued a title in my name but the title was lost or stolen. I certify that the vehicle is worth $1250 or less
and is at least eight model years old.
I know that this statement will be filed with the New York State Department of Motor Vehicles (NYS DMV) and I certify that all of the
information contained herein is true to the best of my knowledge. Knowingly making a false written statement is a misdemeanor pursuant to
Section 210.45 of the Penal Law.
This statement may be used only by the vehicle owner who has not obtained a title in his/her name or has lost the title in his/her name. Only
the vehicle owner may use this statement to transfer the vehicle described below to a registered vehicle dismantler, itinerant vehicle collector
(IVC), or a certified scrap processor. The vehicle being transferred must be worth $1250 or less and be at least eight model years old.
This statement may not be used to transfer ownership to a private party or entities not licensed by DMV such as tow truck drivers or charitable
organizations. An entity engaged in the business of vehicle acquisition for the purposes of dismantling or disposal may not use this form to
allege ownership and transfer a vehicle.
OWNER INFORMATION AND CERTIFICATION
PLEASE NOTE THAT THIS IS A TWO-PAGE DOCUMENT INCLUDING IMPORTANT INFORMATION ON THE SECOND PAGE.
DELIVERY AGENT INFORMATION AND CERTIFICATION
Year
Make
Model
VIN
Color
Vehicle Owner Name
Government Issued ID No. of Owner
(Copy of identification must
be attached)
Address of Vehicle Owner
Owner Signature
ç
Signature of Delivery Agent
ç
Date
Signature
ç
Date
I know this statement will be filed with the NYS DMV and I certify that all the information contained herein is true to the best of my
knowledge. Knowingly making a false written statement is a misdemeanor pursuant to Section 210.45 of the Penal Law.
VEHICLE DISMANTLER OR IVC:
If the title document is not available, make a copy of the owner AND delivery agent’s government-
issued identification. Attach the title or photocopies of identifications to this form. Also attach copy 2 of the form MV-907A (Salvage
Certificate). Write “For Parts Only” on the front of the MV-907A.
SCRAP PROCESSOR:
If the title document is not available, make a copy of the owner AND delivery agent’s government-issued
identification. Attach the title or photocopies of identifications to this form.
Within 15 business days after acquiring the vehicle, please send completed forms to:
NYS DMV Title Bureau
PO BOX 2105
Albany, NY 12220-0105
MV-35 (9/13)
Driver Name
Plate on Delivery Vehicle
Date
DOB
Government Issued ID No. of Delivery Agent
(Copy of
identification must be attached)
DISMANTLER, ITINERANT VEHICLE COLLECTOR, OR SCRAP PROCESSOR INFORMATION AND CERTIFICATION
I certify that I paid $1250 or less for the vehicle described above. I certify that there are no undisclosed liens against this vehicle. I know that
the business noted below will file this statement with the NYS DMV. Knowingly making a false written statement is a misdemeanor pursuant
to Section 210.45 of the Penal Law.
Business Name
Business ID No.
Name
Title
THE VEHICLE MAY NEVER BE TITLED AGAIN. IT MUST BE DISMANTLED OR SCRAPPED.
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