MV-603D Rev 08-2005
Disposition Notice
Derelict Vehicle Sale Only
Vehicle Year & Make
Vehicle Identification Number (VIN)
Model Name or Number
Under provisions of Code §40-11-9 OCGA, I declare the aforementioned vehicle to be a derelict motor
vehicle. The mandatory provision of §40-11-9 of the OCGA that requires the vehicle’s value to be less than
$300.00 was obtained by: Check one and submit required proof. If the National Auto Research Black Book,
Georgia Edition, is used, the value of the vehicle is one-half the printed value shown.
NATIONAL AUTO RESEARCH BLACK BOOK, GEORGIA EDITION - A copy of applicable page from
this book must be attached.
Appraisal attached because a similar vehicle is not listed in the Black Book
This is to further certify that the aforementioned vehicle meets the following four (4) conditions required by law for a
derelict vehicle:
Unattended vehicle left on private or public property without a note from the driver. The vehicle was
left unattended on private property for two (2) days without a note or three (3) days on public property
without a note.
A note was left, but the vehicle remained unattended for five (5) days on either public or private
property.
Vehicle is damaged to such an extent that the restoration of the vehicle to an operable condition
would require the replacement of one or more major component parts.
Vehicle is inoperable due to major mechanical breakdown - engine, transmission, or wheels missing,
no coolant, no engine oil, or burned transmission fluid.
Vehicle is seven (7) or more model years old.
Vehicle has no current tag or there is no tag or title information in the Motor Vehicle Division files.
An insurance company or owner to a wrecker service abandoned the vehicle after a. total loss claim
was paid.
OR, this is to further certify that regardless of the model year or book value of the vehicle, it is completely destroyed by
fire, flood or vandalism or is otherwise damaged to the extent that restoration of the vehicle to a safe and operable
condition would require replacement of more than 50 percent of its major component parts.
Appraisal (Written appraisal certifying the extent of damage must be attached.)
The aforementioned vehicle was sold to the person named below solely for the purpose of scrapping, dismantling or
demolishing the vehicle or it was sold for parts only. The vehicle is not to be rebuilt and put on the road again.
Company Name (Buyer’s)
Address (Buyer’s)
City (Buyer’s)
State
Zip
Buyer’s Telephone Number Including Area Code
Price $
Buyer’s Signature
Date
Seller’s Signature
Date
Company Name (Seller)
Seller’s Street Address
City
State
Zip
Seller’s Telephone Number Including Area Code
The completed form should be mailed to:
Original form:
Copies:
Attention: Salvage Section
Dept. of Revenue-Motor Vehicle Division
PO Box 740381
ATLANTA, GA 30374-0381.
To State Motor Vehicle Division, when the derelict motor vehicle is sold
A file copy for both the person purchasing and the person selling this derelict motor vehicle.
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