
State of Colorado
Insurer, Authorized Agent of an Insurer, or
Salvage Pool Declaration for a Salvage or Nonrepairable Title
Upon the sale or transfer of a motor vehicle for which a current Colorado certicate of title has been issued or led and that has become
a salvage vehicle, as dened in section 42-6-102 (17), the purchase or transferee shall apply for a Salvage Certicate of Title. A Salvage
Title may not be issued for off-highway vehicles, snowmobiles, or vehicles classied as a collector’s item, horseless carriage, or street
rod vehicle at the time of damage.
A Nonrepairable Title may only be issued to vehicles designated as a source of parts or scrap.
Any Alteration Or Erasure In The Application May Void The Document
Application for: Salvage Title Nonrepairable Title
Vehicle Identication Number (VIN)
Year Make Body Model Dealer Color CWT Fuel Type
Date Purchased Date of Damage MSRP Taxable Value Odometer Reading and Indicator
Legal Name(s) as it Appears on Identication*
and Address of Owner(S) or Entity
* Statement of One in the Same is required when the
owner’s name on the Secure and Veriable ID differs from
the owner’s name on the application/title.
_________________________________________ and
__________________________ are one and the same.
Reason for Damage:
Accident/Collision Fire Flood Vandalism (Trespass)
Weather (Excluding Hail, explain below) Other (excluding theft,
explain below)
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Estimated Repair Cost (excluding paint) $ _________________________
I certify, under penalty of perjury in the second degree, that the motor vehicle described above has been damaged in excess of the reasonable fair
market value by an event as listed above, excluding hail damage. The vehicle is now considered salvage and there are no liens outstanding against
this vehicle. I understand that the vehicle cannot be registered until it has been repaired to meet the requirements of a roadworthy vehicle as dened
by C.R.S. 42-6-102 (15) and a Rebuilt from Salvage Certicate of Title has been issued. I also understand that if a Nonrepairable Title is issued, this
vehicle may only be used as a source of parts and may not be registered as a complete vehicle.
Printed name of Owner/Agent as it appears on Identication
Owner or Agent Signature Date
Secure and Veriable ID of Owner/Agent:
Colorado DL Colorado ID Other _________________________________________________________
ID # Expires DOB
The undersigned witness afrms that the named owner of the vehicle identied in this document presented the identication described above.
Witness Signature Date
To create joint tenancy with rights of survivorship, there must be specic language declaring such intent, signed under penalty of
perjury in the second degree by all owners. This area is only applicable to multiple owners. If any owner chooses Tenants in
Common or neither box is checked; the Colorado Certicate of Title will be issued as Tenancy in Common.
Owner One
I _____________________________
(print name) request the Colorado Certicate of Title for the Vehicle described above be issued in:
Joint Tenancy With Rights of Survivorship Tenancy in Common
Per C.R.S. 42-6-116; I certify under penalty of perjury in the second degree that the above information is true and correct to the best of my
knowledge.
Owner’s Signature_________________________________________________________ Date__________________________
Owner Two
I _____________________________
(print name) request the Colorado Certicate of Title for the Vehicle described above be issued in:
Joint Tenancy With Rights of Survivorship Tenancy in Common
Per C.R.S. 42-6-116; I certify under penalty of perjury in the second degree that the above information is true and correct to the best of my
knowledge.
Owner’s Signature_________________________________________________________ Date__________________________
DR 2410 (08/06/21)
COLORADO DEPARTMENT OF REVENUE
Division of Motor Vehicles
Title and Registration Section
DMV.Colorado.gov