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SALVAGE CERTIFICATE
For a 1973 or Newer Motor Vehicle
OTHER JURISDICTIONS: D
the vehicle ant.! its major c'

poses unless

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<IAAI SLD 50226011 SALEDOCB>

THIS DOCUMENT IS V<

1.

VEHt:::LE DESCRIPTIOI'o. -

2.

VEHICLE CONDITION

1int pen.)

Stock#:11098489 026203556-0001 Sale Document

..

E Q1917 U

S ON PROOF OF OWNERSHIP

e THIS MUST ALWAYS BE COMPLETED- CHECK ALL BOXES THAT APPLY

0 Vehicle Identification plate missing, altered or defaced

0 Flood damage

0 Rear Clip

0 Cowl

0 Nose

Major component part or parts missing or damaged:

------------------~----~~------.

Air Bag missing or Damaged:

0 Driver

0 Passenger

0Engine

0Transmission

!;]Body

0 Driver side impact

0 Passenger side impact

0Frame

0Front Cut Off

LlNone

0 Driver side curtain

0 Other Specify

0 Passenger side curtain

0 Other Specify

DATE OF ACQUISITION (Month/Day/Year}

A;

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INSURANCE
CO. CODE

ADDRESS (Number (including Apt. No.) and Street}

PREVIOUS PROOF OF OWNERSHIP:

!;;] NYS CERTIFICATE OF TITLE - DOC.

NO

NYS SALVAGE CERTIFICATE- CERT NO~

INSURANCE COMPANY USE ONLY

CHECK ONE BOX ONLY: 0

STOLEN- NOT RECOVERED

0 RECOVERED STOLEN- INTACT

0 RECOVERED STOLEN- STRIPPED

iiJ TOTAL LOSS

INCLUDE EITHER AN APPRAISAL OR TWO PHOTOS OF VEHICLE FROM DIFFERENT ANGLES WITH DMV COPY (COPY 2) UNLESS VEHICLE IS STOLEN -NOT RECOVERED

4.

LIEN INFORMATION List all liens for which a lien satisfaction has not been received. If liens are subsequently satisfied, send form MV-901, Notice of
Recorded Lien, to person to whom the vehicle was transferred.

ADDRESS (Number and Street}

STATE

5.

ZIP CODE

STATE

ZIP CODE

VEHICLE DISPOSITION/ODOMETER DISCLOSURE REQUIREMENTS Federal and state law requires that you state the mileage upon transfer of ownership.
Failure to do so, or not telling the truth about mileage, may resL!It in fines and/or imprisonment. This form will be returned to you if this section is not completed.
CHECK ONE BOX:

ODOMETER DISCLOSURE STATEMENT:

I, the seller, certify that to the best of my knowledge, this vehicle's odometer reads as follows and (check the box which applies}:
,{] Reflects the Actual Mileage 0 Exceeds Mechanical Limits 0 Does Not Show the Actual Mileage -Warning: Odometer Discrepancy '----'--------'----'-"'-"---"'
PRINT NAME OF PURCHASER
PRINT NAME OF SELLER

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DA"I;E ISSUEO

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OWNER'S SOUNDEX I DRIVER LICENSE NO.

OOANP

00556 3 A.

06/20/13
CO-OWNER'S SOUNDEX I DRIVER LICENSE NO.

975-0 02-293-074

NA~~E(S)

ODOMETER CODES

AND ADDRESS OF REGISTERED OWNER(S)

USAA IN SURANCE

A. Actual Mileage
B. Exceeds Mechanical Umits

C/0 IAA
14149 B AN YWIN E ROA C

BP ANDYWI 'E

C. Not Actual Mileage

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0.000209
CVRBRA13171019

M.J 2 0 613

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<IAAI SLD 5163

Stock#: 11336864

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SALE D0 CL>

e Document CFront )

DAMAG E IS 75% OR l ESS OF THE FAIR MARKET VALUE

THIS IS TO CERTIFY THAT A CERTIFICATION OF A TOTAL LOSS CLAIM HAS BEEN FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE
INSURER I INSURED SHOWN HEREON. THIS CERTIFICATE CONSTITUTES EVIDENCE OF OWNERSHIP IN LIEU OF THE CERTIFICATE OF TITLE, SURRENDERED
TO THE MOTOR VEHICLE ADMINISTRATION UPON ISSUANCE OF THIS DOCUMENT.

THE ADMINISTRATION WILL NOT BE RESPONSIBLE FOR FALSE OR FRAUDULENT ODOMETER STATEMENTS MADE IN THE ASSIGNMENT OF THE SALVAGE
CERTIFICATE OR FOR ERRORS MADE IN RECORDING BY THE ADMINISTRATION.

ISSUANCE OF THIS CERTIFICATE DOES NOT IMPLY THAT THE DESCRIBED VEHICLE COMPLIES
WITH FEDERAL, STATE OR LOCAL ENVIRONMENTAL CONTROL OR SAFETY STANDARDS.

CERTIFICATION OF MARYLAND SALVAGE INSPECTION BY POLICE AGENCY

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I, THE UNDERSIGNED AUTHORIZED REPRESENTATIVE OF THE POLICE AGENCY NAMED BELOW, HEREBY CERTIFY THAT, I HAVE INSPECTED THE VEHICLE
DESCRIBED ABOVE AND VERIFIED THE VEHICLE HAS BEEN RESTORED AND THE VEHICLE IDENTIFICATION NUMBER IS CORRECT

NAME OF POLICE AGENCY MAKING INSPECTION

SIGNATURE OF POLICE REPRESENTATIVE

ID OR BADGE NUMBER

PRINTED NAME OF POLICE REPRESENTATIVE

POLICE REPORT NUMBER

INSPECTION DATE

VR-1 08 (05-11 )

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cER~~~~FICATE oF l~ITLE I I I FOR A ~v 'EHictLE

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KEEP IN SA~E PLACE~II:r''ANY ALTER

VE~itthES,

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1,!11 N OR ~: R~SURE VOID 1 :, HIS TITL.Em,

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' APPUCATIQ~ ~PR A CERTIFICATE/ ~ ~ ~ITLE HAS BE~b MADE FOR THE VEHIC:L~E~<,?~~;g~,~~~i!l

~~ E,FlEBY

THE DEPARTMENT F MOTOR

coMMONWE;.JI'rr-/ bF VIRGINIA,
CERTIFIES T
HEREON PURSUANT TO THE PROifiSIONS OF THE MOfoR VEHICLE LAWS OF THIS COMM
LTH, THAT THE APPLICANT NAMED ON THE FACE HEREON HAS BEEN DULY R'
THE LAWFUL OWNER OF SAID VEHICLE, AND THAT, FROM THE STATEMENTS OF THE OWNER AND THE RECORDS ON FILE WITH THIS DEPARTMENT, THE HEREON DESCRIBED
SUBJECT TO THE SECURITY INTEREST RECORDS ON FILE WITH THIS DEPARTMENT, AND AS DESCRIBED HEREON , IF ANY. THE MOTOR VEHICLE LAWS OF THIS COMMONWEALTH
OF MOTOR VEHICLES IS
I
AND ONLY SUBJECT TO DISSEM INATION TO
THAT ALL TITLE AND REGISTRATION l~f P.RMATION IN THE OFFICE OF THE .. .
AGENCIES, BUSINESS ORGANIZATIONS
~GENTS, GOVERNMENTAL ENTITIES ' INDIVIDUALS UNDER THE
BY MOTOR VEHICLE CODE SECTIONS 46.2-208,
AND 46.2-210.
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Name(s) and address(es) of vehicle

PROGRESSIVE CASUALTY INSURANCE

5920 LANDERBROOK OR
MAYFIELD HEIGHTS l 111,9 lH 44124-6506
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NO LIENS
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I cert1fy to the best of my

0 1. The mileage stat

ODOMETER READING

(No Tenths)

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knowled
t the odometer ding is the actual mileage of the vehicle unless one of the following statements is checked:
cess-6fiiSiil ch
tmits. 0 2. The odometer rea<;ling is not the actual mileage.
WARNING-ODOMETERDISCREPANCY.
Printed Name of Selle~{~ :::::--....-::o::,--,----------------1
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Pri~~~~ INI arne of Buyer(s) +'--"!'1 ~- - --:::.:--=:-::-----:-.;:--'-'-.:,....---...;-::--.--!
am aware of lh.e',EI.bove odomel~r C~rtification made by w~ Seller(s)
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am aware of the ati~~e odometer certification made by the Se!.\ ~r(s)

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Slghature of Buyer,(s)

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Signature of Seller(s)

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Z-975-001-809-983
NAME(S) AND ADDRESS OF REGISTERED OWNER($)

ODOMETER CODES

STATE FARM MUTUAL AUTO INS

1 STATE FARM DR
FREDERICK MD 21701-9332

A. Actual Mileage

B. Exceeds Mechanical Limits

C. Not Actual M1leage

CAri lEV

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<IAAI SLD 50677771 SALEDOCC>

Stock#=10937081 20245M743 Sale Document <Front>

DAMAGE

G~E~TR

THAN 7% lND REPA1RARL

THIS IS TO CERTIFY THAT A CERTIFICATION OF A TOTAL LOSS CLAIM HAS BEEN FILED WITH THE MOTOR VEHICLE ADMINISTRATION IN THE NAME OF THE
INSURER I INSURED SHOWN HEREON. THIS CERTIFICATE CONSTJTUTES EVIDENCE OF OWNERSHIP IN LIEU OF THE CERTIFICATE OF TITLE, SURRENDERED
TO THE MOTOR VEHICLE ADMIN ISTRATION UPON ISSUANCE OF THIS DOCUMENT

THE ADMINISTRATION WILL NOT BE RESPONSIBLE FOR FALSE OR FRAUDULENT ODOMETER STATEMENTS MADE IN THE ASSIGNMENT OF THE SALVAGE
CERTIFICATE OR FOR ERRORS MADE IN RECORDING BY THE ADMINISTRATION.

ISSUANCE OF THIS CERTIFICATE DOES NOT IMPLY THAT THE DESCRIBED VEHICLE COMPLIES
WlTH FEDERAL, STATE OR LOCAL ENVIRONMENTAL CONTROL OR SAFETY STANDARDS.

CERTIRCATION OF MARYLAND SALVAGE INSPECTION BY POLICE AGENCY

I, THE UNDERSIGNED AUTHORIZED REPRESENTATIVE OF THE POLICE AGENCY NAMED BELOW, HEREBY CERTIFY THAT, I HAVE INSPECTED THE VEHICLE
DESCRIBED ABOVE AND VERIFIED THE VEHICLE HAS BEEN RESTORED AND THE VEHICLE IDENTIFICATION NUMBER IS CORRECT

NAME OF POLICE AGENCY MAKING INSPECTION

SIGNATURE OF POLICE REPRESENTATIVE

ID OR BADGE NUMBER

PRINTED NAME OF POLICE REPRESENTATIVE

POLICE REPORT NUMBER

INSPECTION DATE

VR-108 (05-11 )

\6 ysq78dNonrepairable Certificate

VSA-02 N (REV 08/06)

CONTACT DMV IF ANY INFORMATION IS INCORRECT.

Title Number

Veh Identification Number (VIN)

95 4 93758

4T3BA3BB9CU030300
Vehicle Body

Vehicle Make

Model Yr

WG

TOYOTA

201 2

VA Ti t l e Rec e ived Fr o m:
THE TITLE TO THIS VEHICLE HAS BEEN RECEIVED
AND CANCELLED BY THE VA DEPARTMENT OF MOTOR
Vehicles on 0 1 /25/2013 due t o its being
NON - REPAIRABLE

UNITED SERVI CES AUTO ASSOC

5 900 NORTH HAMPTON BLVD
NORFOLK
VA 23502

MERCURY SWITCHES NOT REMOVED

296
CFOOll

VSA-0 (08/06)

~amv.
www . dm 't NOfl) . com
Virgin ia law requires you to notify DMV if you sell , trade or dispose of your vehicle or if you change your address .

If Your Vehicle Has Been Sold, Traded or Disposed of:

I SOLDrfRADED/DISPOSED OF DATE

VEHICLE WAS SOLDrfRADED/DISPOSED OF:

IN VIRGINIA

OUT OF STATE (enter state name)

Mail this entire registration card to DMV, Attention : Data Integrity, P.O. Box 27412, Richmond , Virginia 23269-0001

If Your Are Changing Your Address- use one of the following methods to notify DMV.
- Visit the DMV web site at www.dmvNOW.com , select Address Change and complete the online transa ction .
- Vi sit the DMV website at www.dmvNOW.com , select Forms and Publications- form ISD-01 , Address Change Request
Complete form and send to DMV, Attention Data Integ rity, P.O. Box 27412 , Richmond Virginia 23269-0001.
-Call DMV at (804) 497-7100 and a customer service representative will assist you .
Afte r your address change request is processed , all DMV mail addressed to you , including vehicle registration renewa l
and driver's license renewal notices , will be sent to the new address .

If you change your residence/home address or mailing address to a non-Virginia address your driver's license
or your photo ID card may be cancelled.

DI/IIII/II/IIII/!~~!!DIIP~~IIll/11/IllDIIIII/I/DIII/I/HI
Stock# :

113459?~/~J:Je~,7s

SALE D 0 C A>
a l e Document

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Bltf of sale

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EDM@SfOIQJJe gocKb7tL ttO
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I, (name:)

3 19 kU

of (address: )
$0?5_2__, hereby certify that I am
' , ' . . , , I. .
,

/1/1 J

OWner Of. tflis; \l'eQiCfe:

t~e la\.yfu,J

Year J.OOS
Make_ KT M
Model -50.c c
VIN#. .
Cj ))oQa2_:t'~h

Jlij

and have the authority to seli it. I hereby acknowledge th~ receipt of
$ 5' 0 0
. jn the form 'of CAS l-f . , from (Buyer's name:}
. .
: . . ':ps .full; paymentfor. ,t~e purchase of the said veh.icle,
. ,, ,
W~tth IS 6o1d A6 15 . J hereby state that the mileage oHhe vehicle at the time of
sale is

------

I do hereby grant, sell and transfer full ownership of this vehic~e to the buyer. I,
certify that this vehicle, at the .time of sale, is free from all encumbrances, taxes,
fees and liens except as those specified on the Title or Hsted below; and that, I
(~eller) will .defend and be h~ld fully respol")sible-for such lawful claims and
demands With respect to the vehiCle, if any. .
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Buyer accepts tun liability for the vehicle, damages, and ahy third party liability
incurred from the vehicle use from the date of sale. .
If applicable, Seller agrees to make arrangements for the re<:lsonable delivery of
vehicle title from lien hofdE;r to buyer immediat~ly .
'

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Date

Buyer's' Signature

Date

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