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Please use this form to correct a mileage recording on a title issued with repossession papers. The original title issued with incorrect mileage must be mailed to Maggard for the correction to be processed.

Lienholder Information
Name  
Address  
Zip Code  
City  
State  
County  

Vehicle Description
VIN  
Year  
Make  
Body Type  
Doors  
Type of Power  
Cylinders  
Unladen Weight  
Color  
Odometer Reading
(in miles)
 
Mileage Brand
Vehicle's ODOMETER
has room for how many numbers?
 
For Other Vehicles  
For trailers and commercial vehicles
MAX Gross Weight

Borrower Information
Name  
Address  
Zip Code  
City  
State  
County  

State Last Registered  
State Last Titled  
described was repossessed in on  
The borrower was in default of a security contract dated:  
Proper notice has been given to the following parties:
(list names and addresses)
Police Agency (Pick One)
Police Agency (OR Enter Other)  
Date Notified  

Commissioner of Motor Vehicles(district office)
 
Date Notified  
Owner
(other than lienholder)
 
Date Notified  
Other (Co-Buyer)
Date Notified  

 
 

I certify that, to the best of my knowledge, the mileage of the above-disclosed vehicle's odometer reading: (Select One)

 
DAMAGE DISCLOSURE STATEMENT
I certify that, to the best of my knowledge, this vehicle:

wrecked, destroyed or damaged to such an extent that the total estimate, or actual cost, of parts and labor to rebuild or reconstruct the vehicle to the condition it was in before an accident, and for legal operation on the road or highways, is more than 75% of the retail value of the vehicle at the time of the loss. (Checking the "has been" box means the vehicle must have an anti-theft examination before being registered, and that the title issued will have the statement "Rebuilt Salvage: NY" on it.)

 

 
Reference Number
Name of person submitting form  
Daytime Phone  
Email Address    
THIS TRANSACTION OR SERVICE IS ALSO AVAILABLE, AT NO CHARGE, DIRECTLY FROM THE OFFICIAL DEPARTMENT OF MOTOR VEHICLES WEBSITE AT WWW.NYSDMV.COM