Form 78-021 at a glance
What it is: Application for Inspection of a Salvage/Rebuilt Vehicle is the application to the Department of Public Safety for inspection of a rebuilt vehicle.
Who signs: The undersigned hereby affirms to be the owner(s) of the described vehicle.
Every Mississippi owner of a vehicle which has been rebuilt is subject to Title 35 Part VII of Mississippi Admin. Code, and must title said vehicle in his name prior to transferring ownership.
When a salvage title or other branded title is assigned to you by the insurer, inspection of the rebuilt vehicle is required prior to making application for title.
What to bring and attach to Form 78-021
At the time of inspection, the following documentation must be presented: Application for inspection of a Salvage/Rebuilt Vehicle (Form 78-021), and notarized bills of sale for each major component part, including: name and address of person the part was purchased from, the year, make, model, and vehicle identification number of vehicle from which the part was removed.
Present an invoice for each minor component part, containing complete information as to source, etc., except notarization not required (see 1 immediately preceeding).
Present the original Application of Certificate of Title wherein the re-builder is shown as owner (re-builder required to title prior to re-sale).
Present four (4) pictures (color) to DPS.
A filled-in Form 78-021 example: an owner applies for inspection of a rebuilt car
How to fill out Form 78-021, box by box
Owner Information
Under Owner Information, enter the Sales Tax Account #, Designated Agent #, Name, Doing Business As, Mailing Address, City, State, Zip Code and Phone (Home) and (Work).
Application For
Under Application For, check Clear Title or Rebuilt Title.
The vehicle and its Odometer Reading
Enter when the vehicle was acquired, and its VIN (Vehicle Identification Number), Make, Year, Model, Body Type and Odometer Reading.
For the Odometer Reading, check Exceeds Limits or Not Actual.
Applicant makes application for inspection of the vehicle which has been completely restored by applicant in this state (Mississippi) to its operating condition which existed prior to the event which caused the attached salvage certificate of title, permit to dismantle, total loss certificate, or similar type certificate to issue.
Component parts repaired or replaced
Applicant states that no parts listed have been changed, or if any of the parts listed have been changed, same are listed.
For each part, enter "1" for parts replaced and "N" for new or "U" for used, or enter "2" for parts repaired, then identify vehicle(s) from which parts were removed and attach bills of sale.
For each part, enter the Vehicle Identification Number, Year, Make and Acquired From.
Notarized bills of sale of major component parts and transmission (listing the manufacturer's vehicle identification number of the vehicle from which the parts were removed) must accompany the application. Bills of sale must be provided for minor component parts.
Under Major Component Parts Repaired or Replaced, list Cowl or Firewall, Front-end assembly, Rear clip including roof panel, Roof panel when separately repaired or replaced, Frame, or any portion thereof or, in the case of a unitized body, the supporting structure which serves as the frame, and Motor or engine (replaced).
For a truck, truck type or bus type vehicle, list Frame, or any portion thereof or, in the case of a unitized body, the supporting structure which serves as the frame, Cab, Cargo compartment floor panel or passenger compartment floor plan, Transmission or transaxle (replaced), Motor or Engine (replaced) and Roof panel when separately repaired or replaced.
Minor parts and motorcycle parts
All minor parts bearing full or partial vehicle identification numbers are to be listed.
Under Motorcycle Parts Replaced, list Engine or Motor, Transmission or transaxle, Frame, Front fork and Crankcase.
Other parts and the original VIN plate
Under Other Parts Replaced or Repaired, list what was done to restore said condition which existed prior to the event which caused the attached salvage certificate of title, permit to dismantle, total loss certificate, or similar type certificate to issue (painting, replaced glass, etc.).
List the original manufacturer's public VIN. Said Plate (DOES) or (DOES NOT) remain properly attached in location and that said plate number (HAS) or (HAS NOT) been altered or mutilated in any way.
Signing the application
Owner/rebuilder further states that: (1) Owner/rebuilder rebuilt the vehicle or supervised its rebuilders, (2) Owner/rebuilder personally inspected the completed vehicle and it complies with all safety requirements set forth by the State of Mississippi and any regulations promulgated thereunder, (3) The identification numbers of the restored vehicle and its parts have not, to the knowledge of the owner, been removed, destroyed, falsified, altered or defaced, (4) The salvage certificate document or out of state title certificate attached to the application has not to the knowledge of the owner/rebuilder been forged, falsified, altered or counterfeited, and (5) All information contained on the application and its attachments is true and correct to the knowledge of the owner.
Type or print the name, sign as Signature of Applicant and enter the Date.
Affirm under penalties of perjury that all information contained in this affirmation and its attachments are true and correct to the best of your knowledge.
More rules for Form 78-021
Make two (2) copies for the Department of Public Safety Inspector and retain a copy for owner records.
Complete and submit the application with the vehicle completely restored and ready for inspection.
When the insurer transfers his or her interest by reassignment, you must complete Forms 78-021 and 78-021(1) and have required evidence of ownership of parts, but no inspection is required unless instructions are given to have the vehicle inspected.
When the insurer has sold the vehicle to a re-builder, the re-builder is not required to apply for a new Certificate of Title until the vehicle has been rebuilt, at which time he must apply for a new Certificate of Title in his or her name.
Once the vehicle has been rebuilt and is ready for inspection, complete the Application for Inspection of Salvage/Rebuilt Vehicle (Form 78-021), have four pictures, and arrange with the Department of Public Safety to have said vehicle inspected.
Title 35 Part VII of Mississippi Admin Code Chapter 02 requires 4 pictures of the vehicle to be rebuilt. Pictures are to show the vehicle before any work is done toward rebuilding. Provide the pictures at time of inspection.
If any of the listed forms have been altered, the application is subject to being rejected.
The Department of Revenue may require inspection of any vehicle prior to retitling.
Common questions about Form 78-021
Does it need a notary?
Bills of sale and invoices for parts used in rebuilding said vehicle must be made out to the re-builder and contain the signature of the seller. Only major components bills of sale require notarization.
Is there a deadline?
Inspection is required prior to transfer.
Where do I file it?
Upon successfully passing inspection, the rebuilder assembles his application for Certificate of Title, including the documentation and the Mississippi Department of Safety Completion/Certification of Vehicle Inspection (Form 78-022). The remittance advice and fee of $9.00 for each title application may then be forwarded to the Department of Revenue. (checked October 29, 2026)
Are there fees?
A fee of $75.00 is due in the form of certified check, payable to the Department of Public Safety, at the time of inspection (fee is due whether vehicle passes or fails inspection, and upon each re-inspection). (checked October 29, 2026)
Where to get help with Form 78-021
Questions concerning this instruction may be made by calling (601) 923-7200 and asking for information on titling of rebuilt vehicles.
Questions on inspection must be made to personnel with the Department of Public Safety substation where vehicle is to be inspected.
Sources
[1] Form 78-021 (Rev. 08/17), Application for Inspection of a Salvage/Rebuilt Vehicle, Mississippi Department of Revenue (the Official source link on this page).