Free MV2849 Title Application Branding Notification - Wisconsin

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TITLE APPLICATION BRANDING NOTIFICATION
MV2849 9/2008 s.342.06, 342.065(1)(c) Wis. Stats.

Title Number


Received - Date - Opened Amount Received
Check Cash


Definition of Salvage Vehicle: s.340.01(55g) Wis. Stats. "Salvage vehicle" means a vehicle less than 7 years old that is not precluded from subsequent registration and titling and that is damaged by collision or other occurrence to the extent that the estimated or actual cost, whichever is greater, of repairing the vehicle exceeds 70% of its fair market value. The term does not include a hail-damaged vehicle unless the vehicle is repaired with any replacement part, as defined in s.632.38(1)(e) Wis. Stats. Check: Title Only or Notification Only. Title Only - Transfer to insurance company. Complete Section A. Submit this application with the original title and appropriate fee. By obtaining a title only without registration, operation of the vehicle is not permitted upon public highways. Check all applicable brands from list below. Notification Only - Owner is retaining the vehicle. Complete Sections A and B. A claim has been paid for a vehicle less than 7 years old, and the title needs to be branded. The Department will issue a new, branded title to the owner. Check all applicable brands from list below. Salvage - The vehicle is less than 7 years old and was damaged to the extent that the estimated or actual repair cost, whichever is greater, exceeds 70% of its fair market value. Insurance Claim Paid - The vehicle is less than 7 years old and was transferred to an insurer upon payment of a claim for damages of 30% through 70% of its fair market value. Flood Damage - The vehicle was damaged by flood to the extent that the estimated or actual repair cost, whichever is greater, exceeds 70% of its fair market value. Hail Damage - The vehicle is less than 7 years old and was damaged by hail to the extent that the estimated or actual repair cost, whichever is greater, exceeds 70% of its fair market value. Previous Police - The vehicle was previously used as a police vehicle by a law enforcement agency. Previous Taxi - The vehicle was previously used as a taxicab or for public transportation.

Section A
Vehicle Year

This form cannot be used if a lien is to be listed. Make sure: The odometer information on the title is completed and all previous owners named on the title have signed the assignment area of the title.
Make Model Color Vehicle Identification Number

Insurance Company Name

FEIN

Claim Number

Street Address

Date Damage Occurred

Date Acquired

City

State

ZIP Code

Area Code - Telephone Number

Title Fee $69.50 Total Fees Due Walk-in Fee $5.00 Priority Service Fee $4.00

Section B
Owner Name

A claim has been paid to the vehicle owner(s) named below for vehicle damage exceeding 70% of the fair market value. The owner is keeping the vehicle.
Date Damage Occurred

Address, City, State, ZIP Code

Title is attached Note to owner: Wisconsin law requires the owner of a salvage vehicle to apply for a salvage certificate of title. A person who violates this provision may be required to forfeit up to $5,000. If you did not provide title to the insurer, send this form with your title to the address below.

Regular Service Mail to: Wisconsin Department of Transportation PO Box 7949 Madison WI 53707-7949 Make check payable to: Registration Fee Trust

Priority Service: Include an additional $4.00 Mail to: Wisconsin Department of Transportation PO Box 7306 Madison WI 53707-7306 I certify the information on this application is true and correct.

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(Owner/Insurance Company Authorized Agent - Print Name) (Owner/Insurance Company Authorized Agent Signature) (Date)

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