Form Inv 26 15 – Fill Out and Use This PDF

APPLICATION FOR INSPECTION OF A SALVAGE VEHICLE AND AFFIRMATION SUPPORTING SALVAGE CERTIFICATE

OWNER INFORMATION	REBUILDER’S LICENSE NO. ____________________________		RESIDENT ADDRESS IF DIFFERENT
NAME __________________________________________________________________		_______________________________________________________________________
MAILING ADDRESS ______________________________________________________		_______________________________________________________________________
CITY__________________________________ STATE ________ ZIP _______________		PHONE _________________________________________________________________
PHYSICAL LOCATION OF VEHICLE FOR INSPECTION PURPOSES		LIENHOLDER INFORMATION
	(DO NOT LIST ROUTE ADDRESSES)	NAME ___________________________________________ LIEN DATE ____________
_______________________________________________________________________		STREET ADDRESS ______________________________________________________
_______________________________________________________________________		CITY__________________________________ STATE ________ ZIP _______________
COUNTY:		LIST ALL ADDITIONAL LIENS ON A SEPARATE SHEET AND ATTACH

The undersigned hereby affirms to be the owner(s) of the following described vehicle which was acquired on ______________________________________________________________

(Date)

_____________________________________________________________________________________________________________________________________________________

VEHICLE IDENTIFICATION NUMBERMAKEYEARMODELBODY TYPEODOMETER READING

_____________________________________________________________________________________________________________________________________________________

PREVIOUS TITLE NUMBER

TITLE STATE

CYLINDERS

NEW

USED

DATE OF PURCHASE

NO. LIENS

COLOR

Applicant hereby makes application for inspection of the above described vehicle which has been completely restored by applicant in this state (ALABAMA) 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. Applicant further states that no parts listed below have been changed, or if any of the parts listed below have been changed, same are listed. 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 this application. Bills of sale must be provided for minor component parts.

COMPONENT PARTS (AS DEFINED IN ACT 89-863, 1989 ALABAMA LEGISLATURE REGULAR SESSION)

TRUCK, TRUCK TYPE OR BUS TYPE VEHICLES

1.	6	Frame or any portion thereof.
2.	6	Cab.
3.	6	Cargo compartment floor panel or
		passenger compartment floor pan.

4.6 Transmission or trans-axle.

MINOR COMPONENT PARTS REPLACED

1.	6	Transmission. (Passenger vehicle only)
2.	6	Other.

APPLICANT FURTHER STATES THAT THE FOLLOWING WAS DONE TO RESTORE SAID VEHICLE 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: (PAINTING, RE-

PLACED GLASS, ETC.)

List the original manufacturer’s public vehicle identification number:

Said plate 6 (DOES) or 6 (DOES NOT) remain properly attached in its original location on the vehicle and that said plate and number 6 (HAS) or 6 (HAS NOT) been altered or mutilated in any way. Applicant further states that: (1) Applicant rebuilt the vehicle or supervised its rebuilders. (2) Applicant personally inspected the completed vehicle and it complies with all safety requirements set forth by the State of Alabama 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 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.

I affirm, under penalties of perjury, that all information contained in this affirmation and its attachments is true and correct to the best of my knowledge.

TYPE OR PRINT NAME OF APPLICANT

SIGNATURE OF APPLICANT

DATE

APPLICATION FEE OF $75.00 AND TITLE FEE OF $15.00 (CERTIFIED FUNDS) MUST ACCOMPANY THIS APPLICATION. DO NOT SUBMIT THIS APPLICATION UNTIL THE VEHICLE IS COMPLETELY RESTORED AND READY FOR INSPECTION.

COMPONENT PARTS (As defined in Act 89-863, 1989 Alabama Legislature Regular Session)

PASSENGER VEHICLES

	TRUCK, TRUCK TYPE OR BUS TYPE VEHICLES
	MAJOR		MINOR
1.	Motor or engine.
2.	Transmission or trans-axle.	1.	Each door allowing entrance to or egress from the
3.	Frame or any portion thereof (except frame horn), or, in		passenger compartment.
	the case of a unitized body, the supporting structure which	2.	Hood.
	serves as the frame.	3.	Grill, except on one ton or smaller trucks.
4.	Cab.	4.	Each bumper.
5.	Cowl, firewall, or any portion thereof.	5.	Each front fender.
6.	Roof assembly.	6.	Roof panel and rear cab panel.
7.	Cargo compartment floor panel or passenger compart-	7.	Each rear fender or side panel.
	ment floor plan.	8.	Pickup box.
		9.	Body or bed.

MOTORCYCLES

1.Engine or motor.

2.Transmission or trans-axle.

3.Frame.

4.Front fork.

5.Crankcase.