OKLAHOMA TAX COMMISSION/MOTOR VEHICLE DIVISION
FORM 780-B
UNOBTAINABLE OWNERSHIP DOCUMENTATION AFFIDAVIT
INSURANCE COMPANY AFFIDAVIT FOR ISSUANCE OF A
SALVAGE CERTIFICATE OF TITLE
PURSUANT TO 47 OKLAHOMA STATUTES SECTION 1105(P)
The legislation providing for submission of Form 780-B (Unobtainable Ownership Documentation Afidavit) becomes effective July 1, 2012.
No completed Afidavit will be accepted prior to July 1, 2012.
Form 780-B
Created 5-2012
MVC |
OKLAHOMA TAX COMMISSION/MOTOR VEHICLE DIVISION |
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UNOBTAINABLE OWNERSHIP DOCUMENTATION AFFIDAVIT |
INSURANCE COMPANY AFFIDAVIT FOR ISSUANCE OF A SALVAGE CERTIFICATE OF TITLE
PURSUANT TO 47 OKLAHOMA STATUTES (OS) SECTION 1105(P)
(Refer to Page 2 for Important Information Relating to this Afidavit.)
This unobtainable ownership documentation afidavit is presented on behalf of:
Name of Insurance Company: ________________________________________________________________________
Address of Insurance Company: ______________________________________________________________________
_____________________________________ |
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____________________ |
City |
State |
Zip |
for issuance of a Salvage Certiicate of Title on the following vehicle:
Year: ______________ Make: _____________________________ Model: _____________________________
VIN or Oklahoma Title Number: _______________________________________________________________________
Insured Owner’s Name: _____________________________________________________________________________
This afidavit is being submitted pursuant to the provisions of 47 OS Sec. 1105(P), following a total loss settlement with the insured:
•Date of Total Loss Settlement Acceptance: ___________________ (30 days must elapse since date of settlement acceptance by the insured, before this afidavit may be submitted.)
At least two (2) written attempts to secure proper titling documentation from the insured owner have been made, as noted below. Those attempts have been unsuccessful.
• Date of 1st Written Attempt: __________________ |
Date of 2nd Written Attempt: ___________________ |
**Photocopies of both written attempts must be attached, along with any ownership documentation or information provided by the insured owner.**
My signature below afirms the above information is accurate to the best of my knowledge and belief and that I am authorized by the insurance company listed above to submit this afidavit on their behalf. This afidavit is signed under penalty of perjury.
Signature of Authorized Insurance Company Representative: ________________________________________________
State of Oklahoma, county of ___________________________________________________________
Subscribed and sworn to before me this _____________ day of ___________________ , __________ .
My commission expires: ______________________ , _______________ .
______________________________________________________________________ , Notary Public
Submit or mail this completed afidavit, including all required additional documentation, and your remittance, made pay- able to the Oklahoma Tax Commission, to any Oklahoma tag agency. A listing of agency locations is available in the Motor Vehicle Section of the Oklahoma Tax Commission website at www.tax.ok.gov. If you choose to mail your afidavit and pay- ment to the Oklahoma Tax Commission, please send to the address on the reverse of this form.
Form 780-B - Page 2
OKLAHOMA TAX COMMISSION/MOTOR VEHICLE DIVISION
UNOBTAINABLE OWNERSHIP DOCUMENTATION AFFIDAVIT
Purpose and Use of Form
This afidavit is to be utilized by an insurance company, or their authorized representative, in applying for an Oklahoma Sal- vage certiicate of title to a vehicle following a total loss settlement and unsuccessful attempts to secure proper ownership documentation from the insured owner, pursuant to the provisions of 47 OS Sec. 1105(P), which state:
P. When an insurance company makes a total loss settlement on a total loss vehicle and the insurance company or a salvage pool authorized by the insurance company is unable to obtain the properly endorsed certiicate of ownership or other evidence of ownership acceptable to the Oklahoma Tax Commission within thirty (30) days following acceptance by the owner of an offer of an amount in settlement of a total loss, that insurance company or salvage pool, on a form pro- vided by the Oklahoma Tax Commission and signed under penalty of perjury, may request the Oklahoma Tax Commis- sion to issue the applicable salvage title for the vehicle.The request shall include information declaring that the requester has made at least two written attempts to obtain the certiicate of ownership or other acceptable evidence of title.
Insurance Company Damage Notiication
Insurance companies paying a claim for a loss where the cost of repairing the vehicle for safe operation on the highway exceeds sixty percent (60%) of the market value of the vehicle, or paying a claim for a lood-damaged vehicle as deined in 47 OS Sec. 1105, must notify, in writing, both the record owner and the Oklahoma Tax Commission. 47 OS Sec. 1111(L) states, in pertinent part:
L. Any insurance company that pays a claim for a loss where the cost of repairing the vehicle for safe operation on the highway exceeds sixty percent (60%) of the market value of the vehicle or pays a claim for a lood-damaged vehicle as deined in Section 1105 of this title shall notify, in writing, the holder of the certiicate of title of the requirements of this section and shall notify the Tax Commission of the payment of such claim.The notice shall include the estimated total damage percentage determination of the actual cash value made by the insurance company to repair the vehicle for safe operation on the highway.The insurance company shall also send a copy of the notiication to the holder of the title.
This damage percentage is used by the Commission in determining the proper title type (i.e. Salvage or Junk) to be issued. Flood Damage, when noted, will be relected as a brand on the Oklahoma Certiicate of Title.
•A Salvage title is required when the damage percentage is from 60% to 79%.
•A Junk tile is required when the damage percentage is 80% or greater.
•A Flood Damaged brand is to be added, when applicable.
47 OS Sec. 1105 deines a Flood-Damaged Vehicle as a salvage or rebuilt vehicle which was damaged by looding, or a vehicle which was submerged at a level to or above the dashboard of the vehicle and on which an amount of loss was paid by the insurer.
Please note, as outlined in the statutory language excerpted above, only damage impacting the roadworthiness of
the vehicle need be considered in this notiication to the Commission. Cosmetic damage (i.e. hail) unrelated to road-
worthiness should not be included in this damage computation. Flood damage criteria is outlined immediately above.
Contact Information
Questions regarding the use of this afidavit, or any issue relating to insurance loss damage declarations, may be directed to the Motor Vehicle Division of the Oklahoma Tax Commission at (in state toll free) 1-800-522-8165, extension 13221, or (direct) (405) 521-3221.
Mailing address: Oklahoma Tax Commission Motor Vehicle Division Title Section 2501 Lincoln Boulevard Oklahoma City, OK. 73194
Copies of this afidavit may be downloaded from the Motor Vehicle Forms section of the OTC website at www.tax.ok.gov.
