|   | T-129 (Rev 06-2007) | Department of Revenue - Motor Vehicle Division | 
|   |   | Labor and Part s Cert ificat ion | 
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|   | This is to certify that I , | (Record your full legal name and address below) |   | 
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|   | Full Legal Name & Address: |   |   | 
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repaired the following described vehicle or I had the vehicle repaired by:
Re-builder’s Full Legal Name & Address:
 
Year Model & Make of Vehicle:
 
Vehicle I dentification Number (VI N):
 
 
And this vehicle was rebuilt in accordance with §40-3-37 (b) (2) of Georgia Law. I f applicable, please list below the vehicle identification number(s) of the vehicle(s) from which the used parts were taken:
Vehicle I dentification Number(s) of the Vehicle(s) from which the Used Parts Were Taken:
Location of the parts vehicle(s): (Please list locations below)
 
*A maj or component assembly (Fenders, hood assembly, excluding soft quarter panel).
 
part is any one of the following sub-assemblies of a motor vehicle: (A) Front clip and bumper); (B) Rear clip assembly (Quarter panels, floor panel assembly and the roof tops); (C) Engine and transmission; (D) Frame; (E) Complete side (Fender, door and
 
 
I f this restored vehicle was issued a salvage title and passed the Georgia MVD inspection, the new title, when issued, will be branded ‘Rebuilt ’.
Not e: Submit a copy of your current Georgia re-builder’s license unless the title to the vehicle was issued in your name before the vehicle was declared a salvage vehicle
I f no parts were used to restore the vehicle, check this box:
 
Place an ‘X’ in the box to the left of the name(s) of the part(s) replaced in the repair of the vehicle:
| Front Bumper |   |   |   | Deck Lid |   |   |   |   | Windshield | 
|   |   |   |   |   |   |   |   |   |   | 
| Grille |   |   |   | Rear Body Panel |   |   |   |   | Floor Pan | 
|   |   |   |   |   |   |   |   |   |   | 
| Left Fender |   |   |   | Rear Bumper |   |   |   |   | P/ U Cab | 
|   |   |   |   |   |   |   |   |   | 
| Right Fender |   |   |   | Right Rear Quarter Panel |   |   |   | P/ U Bed | 
|   |   |   |   |   |   |   |   |   | 
| Hood |   |   |   | Right Rear Door or Skin |   |   |   | Left Cab Corner – P/ U | 
|   |   |   |   |   |   |   |   |   | 
| Radiator Support |   |   |   | Right Front Door or Skin |   |   |   | Right Cab Corner – P/ U | 
|   |   |   |   |   |   |   |   |   | 
| Left I nner Fender/ Apron |   |   |   | Roof Skin or Assembly |   |   |   | Back Cab Panel | 
|   |   |   |   |   |   |   |   |   |   | 
| Right I nner Fender/ Apron |   |   |   | Engine |   |   |   |   | I nterior | 
|   |   |   |   |   |   |   |   |   |   | 
| Left Front Door or Skin |   |   |   | Transmission |   |   |   |   | Wheel/ Tires | 
|   |   |   |   |   |   |   |   |   |   | 
| Left Rear Door or Skin |   |   |   | Frame |   |   |   |   | Dash Pad | 
|   |   |   |   |   |   |   |   |   |   | 
| Left Rear Quarter Panel |   |   |   | Frame Section |   |   |   |   | Header Panel | 
|   |   |   |   |   |   |   |   |   |   | 
| Air Bag & Sensors |   |   |   | Suspension Lt . | Rt . |   |   |   |   | 
 
Check all boxes below that apply:
Wrecked
Burned
Recovered Theft
Flood
T-56

 Owner Retained Salvage
 Owner Retained Salvage
Hail Damage

 Other
 Other
 
 
I purchased the vehicle in a repaired condition from: ________________________________________________________
(Seller’s Full Legal Name)
_____________________________________________________________________________________________________
(Seller’s Address including city, state & zip)
Cert ificat ion by Ow ner
To the best of my knowledge, the information contained herein is true and correct . I understand that this vehicle cannot be sold or transferred until a certificate of title has been issued in my name in compliance with §40-3-37 of Georgia Law.
 
Telephone No. Plus Area Code:
 
Alternate Telephone No. Plus Area Code:
 
 
Important: The information on this form must be legible. Alteration or erasure voids this form. Please include photographs of the vehicle in a damaged condition per §40-3-37 and §7-1-90 of Georgia Law. Any person who rebuilds or repairs a salvage motor vehicle shall submit an application for title and obtain an inspection of such vehicle before painting such vehicle.