Fill a Valid Georgia Mv 1S Template

MV-1S (Revised 6-2020)

Georgia Department of Revenue - Motor Vehicle Division

Form MV-1S Motor Vehicle Salvage Title Application

For instructions on how to complete this form see page 2.

AVEHICLE INFORMATION

*Owner’s signature below warrants: I do solemnly swear or affirm 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 fine up to $5,000 or by imprisonment of up to five years, or both that the statements contained herein are true and accurate.

OWNER # 1

Full Legal Name: ____________________________________________ Driver’s License #: __________________ State: ____ _

Date of Birth: ___________ E-mail Address: __________________________________________ Phone #: _________________

Business Name: ____________________________________________ Name of Agent: ______________________________ _

Address: ________ ______________________________________________________________________________________

Mailing Address: _ _______________________________________________________________________________________

*Signature of Owner 1 or Business Agent: ___________________________________________________ Date: ________________

OWNER # 2

Full Legal Name: ____________________________________________ Driver’s License #: __________________ State: ____ _

Date of Birth: ___________ E-mail Address: __________________________________________ Phone #: _________________

Business Name: ____________________________________________ Name of Agent: ________________________________

Address: ________ ______________________________________________________________________________________

Mailing Address: _ _______________________________________________________________________________________

*Signature of Owner 2 or Business Agent: ___________________________________________________ Date: ________________

CSELLER INFORMATION

GA Dealer’s/Bank’s 12 Digit Customer ID # (If applicable): ________________________

Full Legal Name or Business Name:

Address:

If Georgia Seller, County Name: _________________________

DSECURITY INTEREST OR LIENHOLDER INFORMATION -- Attach any information on additional lienholders.

Address: _____________________________________________________________________________________________ _

Address: _____________________________________________________________________________________________ _

EATTORNEY--IN--FACT INFORMATION -- Attach original Power of Attorney if title is to be mailed to attorney -in -fact.

Name: _ _____________________________________________________________________________________________

Mailing Address: _____ ___________________________________________________________________________________

Phone Number: ___________________________ E-mail Address: _________________________________________________

Georgia Department of Revenue - Motor Vehicle Division

Form MV-1S Motor Vehicle Salvage Title Application

INSTRUCTION PAGE

Purpose of this form: This form is to be used when applying for a salvage title and must be signed by all owners in Section B.

How to submit this form: This form must be completed in its entirety, legibly printed or typed, and submitted along with all required documents

to the Department of Revenue (DOR). Please mail to DOR/Motor Vehicle Division, Attn: Salvage Unit, P. O. Box 740384, Atlanta, GA 30374- 0384.

AVEHICLE INFORMATION

This section must be completed in its entirety. If you do not know the district in which you live, please check with your County Tag Office. Include all the requested information: vehicle identification number (VIN), make of vehicle, model of vehicle, current title number, current title’s state of issue, Georgia county of residence, district number (if known), year of vehicle, color, cylinders of vehicle, body style, fuel type, and odometer information including whether exempt, exceeds mechanical limits, not actual mileage.

Also include odometer reading and date purchased.

BOWNER INFORMATION

List the number of owners, whether the vehicle is leased, and if it was purchased out of state.

All owners listed on the title must sign this form. By signing this form you are agreeing to the following:

*Owner’s signature below warrants: I do solemnly swear or affirm 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 fine up to $5,000 or by imprisonment of up to five years, or both that the statements contained herein are true and accurate.

OWNER # 1

For owner number one:

•If an individual, provide the full legal name, driver’s license number, state of issuance, date of birth, e-mail address, telephone number, address, and mailing address (if applicable).

•If a business, provide the e-mail address, telephone number, business name, name of the signer, address, and mailing address (if applicable).

•Signature is required.

OWNER # 2

For owner number two:

•If an individual, provide the full legal name, driver’s license number, state of issuance, date of birth, e-mail address, telephone number, address, and mailing address (if applicable).

•If a business, provide the e-mail address, telephone number, business name, name of the signer, address, and mailing address (if applicable).

•Signature is required.

CSELLER INFORMATION

Provide:

•Georgia dealer’s or bank’s 12-digit customer identification number (if applicable)

•Full legal name or business name and address

•Georgia county name (if applicable)

•Whether the vehicle was directly financed by the dealer

DSECURITY INTEREST OR LIENHOLDER INFORMATION -- Attach any information on additional lienholders.

List the following for the first two security interest or lienholders (attach any additional lienholder information to this form):

•12-digit customer identification number

•Name

•Address

If using a Power of Attorney, attach the Power of Attorney and fill in their:

•Name

•Mailing address

•Phone number

•Email address