TC 96-215: Kentucky Affidavit of Motor Vehicle Assembled from Wrecked or Salvaged Motor Vehicles

Fill in the County in Commonwealth of Kentucky, County of.

Under Section 1: Affiant Information, enter the Dealer or Individual Name, Email, Mailing Address, City, State and Zip Code.

Dealers applying for a rebuilt title will receive a printed title that is already dealer assigned to the dealership. No further action is required before submitting an application for resale.

Under Section 2: Parts Information, enter the Printed Name of Seller and the Part(s) Purchased.

For the Printed Name of Seller and Part(s) Purchased, if salvaged parts were used, attach list of salvaged part(s). Include a description of each salvaged part and the VIN # of the vehicle from which the part was taken.

Enter Additional comments/explanations.

Under Section 3: Vehicle Description, enter the Vehicle Identification # (VIN), Make, Model #, Body Style and Model Year.

If motorcycle, provide motor #.

For a rebuilt motorcycle, provide pencil tracings or photos of both the engine and frame identification numbers (VIN #s).

If a replacement engine was used, an effort should be made to obtain the frame number of the motorcycle from which the engine was taken.

Under Section 4: Affiant Statement & Notarization, you affirm that the motor vehicle named in Section 3 above has been reconstructed from parts taken from other motor vehicles which have been obtained from the seller(s) named in Section 2 above and that you are the sole owner of the vehicle that has been produced, which is clear of all liens. Enter the Affiant Signature, your Title and the Date.

The notary enters Sworn or affirmed before me on this date, My commission expires, My commission # is, and the Notary Signature and Title.

If parts were purchased from individuals and not businesses, the applicant shall submit a written statement from the seller giving the seller's name, address, and telephone number, the part or parts sold, and the VIN number of the vehicle from which the parts were taken.

If the VIN number is unknown, the seller shall submit a statement explaining the reason it cannot be provided.

If a vehicle is not 75 percent or more damaged, provide a statement from the insurance company on company letterhead describing the extent of damage to the vehicle.

If the vehicle was purchased at auction, provide the original salvage pool receipt in place of an insurance statement.

Submit the completed forms:  TC 96-215 form, Affidavit of Motor Vehicle Assembled from Wrecked or Salvaged Motor Vehicles  TC 96-353 form, Labor Statement for Rebuilt or Total-Loss Vehicle  TC 96-182, Application for Kentucky Certificate of Title or Registration, completed, signed, and notarized for the buyer and seller if any of the following apply: o Application is for an out of state vehicle o Vehicle that is “junked” in the Kentucky system o Affidavit of total consideration is being used

All applications must be submitted by doing one of the following: Submit to County Clerk. Mail to: Kentucky Transportation Cabinet, Attn: Rebuilt Section, PO Box 2014, Frankfort, KY 40622-2014. Place in drop box at entrance of Transportation Cabinet Office, 200 Mero Street, Frankfort, KY 40601. Drop-off hours: Monday through Friday, 8:00 a.m. to 4:30 p.m.

PENALTIES KRS 186A.990: Any person who knowingly gives false, fraudulent, or erroneous information in connection with an application for the registration, and when required, titling of a vehicle, or any application for assignment of a vehicle identification number, or replacement documents, or gives information in connection with his review of applications, or falsely certifies the truthfulness and accuracy of information supplied in connection with the registration and when required, titling of a vehicle, shall be guilty of forgery in the second degree.