wrecker/salvage processor monthly report · 2019-09-16 · x yes no yes no yes no yes no yes no yes...

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X Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Wrecker/ Salvage Processor Monthly Report Select how you will submit your report. NOTE: Reports not submitted electronically require original signature and notary seal. List each vehicle acquired in the previous month. If no vehicles were acquired, select “none.” Reports are due by the 10th of the month following the month the vehicles were acquired. IMPORTANT – Keep copies of this report and all supporting documents verifying ownership. How are you submitting report? Business name Wrecker/Processor license # Month/Year vehicles acquired Acquisition activity Internet U.S. mail 20 None Date Wrecker only Motor or vehicle Vehicle Supporting Title number acquired meets value Stock / Yard number Year Make Identification number type* Plate number State documents (if applicable) (xx/xx/xx) Acquired from threshold *Vehicle type: AU - Auto, BT - Boat, MC - Motorcycle, MOB - Mobile home, TK - Truck (includes motorhomes), TL - Trailer, OT - Other Company email: TD-420-538 (R/9/19)W By typing or signing your name,* you certify that: (1) this is a list of all vehicles and vehicle salvage legally acquired during the report month; (2) all vehicles and/or license plates listed have been destroyed. Wrecker/ Salvage processor signature* *If using Submit to DOL button – certify by typing your name.

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Wrecker/ Salvage Processor Monthly Report• Select how you will submit your report. NOTE: Reports not submitted electronically require original signature and notary seal.• List each vehicle acquired in the previous month. If no vehicles were acquired, select “none.” Reports are due by the 10th of the month following the month

the vehicles were acquired.• IMPORTANT – Keep copies of this report and all supporting documents verifying ownership.

How are you submitting report? Business name Wrecker/Processor license # Month/Year vehicles acquired Acquisition activity

Internet U.S. mail 20 NoneDate Wrecker only

Motor or vehicle Vehicle Supporting Title number acquired meets valueStock / Yard number Year Make Identification number type* Plate number State documents (if applicable) (xx/xx/xx) Acquired from threshold

*Vehicle type: AU - Auto, BT - Boat, MC - Motorcycle, MOB - Mobile home, TK - Truck (includes motorhomes), TL - Trailer, OT - Other

Company email:

TD-420-538 (R/9/19)W

By typing or signing your name,* you certify that: (1) this is a list of all vehicles and vehicle salvage legally acquired during the report month; (2) all vehicles and/or license plates listed have been destroyed.

Wrecker/ Salvage processor signature*

*If using Submit to DOL button – certify by typing your name.