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T-129 (Rev 06-2007) |
Department of Revenue - Motor Vehicle Division |
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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 |
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Deck Lid |
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Windshield |
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Grille |
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Rear Body Panel |
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Floor Pan |
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Left Fender |
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Rear Bumper |
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P/ U Cab |
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Right Fender |
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Right Rear Quarter Panel |
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P/ U Bed |
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Hood |
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Right Rear Door or Skin |
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Left Cab Corner – P/ U |
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Radiator Support |
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Right Front Door or Skin |
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Right Cab Corner – P/ U |
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Left I nner Fender/ Apron |
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Roof Skin or Assembly |
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Back Cab Panel |
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Right I nner Fender/ Apron |
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Engine |
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I nterior |
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Left Front Door or Skin |
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Transmission |
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Wheel/ Tires |
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Left Rear Door or Skin |
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Frame |
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Dash Pad |
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Left Rear Quarter Panel |
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Frame Section |
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Header Panel |
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Air Bag & Sensors |
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Suspension Lt . |
Rt . |
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Check all boxes below that apply:
Wrecked
Burned
Recovered Theft
Flood
T-56

Owner Retained Salvage
Hail Damage

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.