Mv 901D Form – Fill Out and Use This PDF

GARAGEMAN’S CERTIFICATIONAND BILL OF SALE FOR

VEHICLES WORTH LESS THAN $500.00

DISPOSAL OF LAWFULLY TOWEDAND/OR STORED VEHICLES UNDER LIEN LAW, SECTION 202

(This form isalso available to download from the DMVwebsite: www.dmv.ny.gov)

NOTICE: THE VEHICLE DESCRIBED HEREIN MAY NEVER BE TITLEDAGAIN. IT MUST BE DISMANTLED OR SCRAPPED. AFTER COMPLETION, PLEASE SUBMIT THIS FORM TO THE VEHICLE DISMANTLER OR SCRAP PROCESSOR. IMPORTANT INFORMATION REGARDING THESE REQUIREMENTS CAN BE FOUND ON FORM MV-901DI.

To knowingly make a false statement or conceal a material fact in this statement is a criminal offense punishable under Section 210.45 of the Penal Law, and Section 392 of theVehicle andTraffic Law.

I, the undersigned GARAGEMAN, certify under penalty of perjury as follows (if signing as an authorized representative of a business organization, suchasacorporation,IcertifythatIpossessthepersonalknowledgetomakesuchcertificationandIamdulyauthorizedtosocertifyonbehalfofthe business): (1) the undersigned currently holds a valid, perfected Garageman’s Lien on the motor vehicle described herein; (2) such lien represents accrued and unpaid towing and/or storage charges which remain unpaid to date; (3) the subject vehicle currently has a wholesale value of less than $500, as indicated by the nationally recognized source checked below; and (4) the undersigned sold this vehicle to the vehicle dismantler or scrap processornamedherein.

1.Description of Vehicle (a statement of acquisition must be attached [see MV-901DI]):

	Year: _______ Make: ________________________		Model: ________________________ Plate Number: ___________________ State:________
	Vehicle Identification Number:
	(attachphotoortracing)____________________________________________			WholesaleValue ofVehicle: $ _________________________
2.	Source of Wholesale Value	NADA	Kelly Blue Book	Other(pleasedescribe)_________________________________________
	relied upon by the undersigned:

3.Garageman (a copy of proof of business must be attached [see MV-901DI]):

Business Name:___________________________________________________ Facility # ___________________			Government Issued IDfor person
BusinessAddress:______________________________________________________		Apt./STE# ____________	submitting this form (copymustbe
			attached):
City:__________________________________________	State: ___________	Zip Code ______________	No.:_________________________

4.Vehicle Dismantler or Scrap Processor:

Business Name:___________________________________________________ Facility # ___________________			Government Issued ID for
			representative of vehicle dismantler
			or scrap processor (copy must be
BusinessAddress:_______________________________________________________ Apt./STE# ____________			attached):
City:__________________________________________	State: ___________	Zip Code_______________	No.:_________________________

5.Prior Owner (a copy of verification of prior owner and other lienholders must be attached):

Name: ___________________________________________________________________________________________________________________

Street

Address:______________________________________Apt./STE# ______City:__________________________ State: ______ Zip Code___________

6.Lienholders (Attachadditionalsheet,ifnecessary)

Business Name:_______________________________________________	Business Name:________________________________________________
Business	Business
Address:______________________________________Apt./STE# ______	Address:______________________________________Apt./STE# ______
City:__________________________ State: ______ Zip Code__________	City:__________________________ State: ______ Zip Code__________

7.Service of Notice and Towing and/or Storage Information (a copy of the Notice of Lien and Sale, and a copy of receipt for mailing must be attached [see MV-901DI]):

Date of Service of Notice to Owner: _______/_______/_______ Date of Service of Notice to Lienholder(s): ______/_______/_______

8.	DateVehiclewasTowed:(Towingauthorizationmustbeattached)	9.	Date Storage Began:	10	Date of Sale:
	______ / _______ / ________		______ / _______ / ________		______ / _______ / ________

I further certify that: the Date of Sale is not (a) prior to thirty days after the date on which Service of Notice was mailed, or (b) prior to sixty days after the date of the initial tow, whichever is later; no action was brought under Section 201-a of the Lien Law, or, an action was brought and the determination was in my (our) favor; and the required Notice of Lien wassent to owner(s) and lienholder(s).Proof of certified mailing is attached.

GARAGEMAN’S/REPRESENTATIVE’S NAME - PRINT

GARAGEMAN’S/REPRESENTATIVE’STITLE

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GARAGEMAN’S/REPRESENTATIVE’S SIGNATURE - Pleasesignnameinfull

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