VR454 VR 454

User Manual: VR454

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Motor Vehicle Administration
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062

VR-454 (10-12)

Affidavit of Lawful Possession for Transfer of a Vehicle to an Automotive Dismantler and Recycler or Scrap Processor
Purpose:	
Use this form to certify, under oath, that a Certificate of Title is unavailable for a vehicle that is being transferred to an Automotive
Dismantler and Recycler or Scrap Processor for purposes of dismantling, destroying or scrapping, and that proper notification has
been made pursuant to Maryland law.
Instructions:	
Complete form in its entirety. This form must be maintained at the place of business and made available upon request to the MVA or
Law Enforcement Officials for a period of at least 3 years. MUST ATTACH:
1.	A COPY OF THE DRIVER’S LICENSE OF THE PERSON PROVIDING THE VEHICLE; AND
2.	BEFORE THE VEHICLE CAN BE DISMANTLED, DESTROYED OR SCRAPPED, COPIES OF VEHICLE OWNER AND LIEN
HOLDER NOTIFICATIONS.
Limitations:	
A vehicle may not be retitled or assigned using this document; it may only be dismantled, destroyed or scrapped. This form cannot
be used for a vehicle towed from a residential or commercial property under a continuing contract to tow unauthorized vehicles.

PROVIDER’S INFORMATION
PROVIDER’S NAME (PRINT)

PROVIDER’S DRIVER’S LICENSE NUMBER

COMPANY NAME

COMPANY PHONE

COMPANY STREET ADDRESS

CITY

IS THE VEHICLE BEING TRANSPORTED BY A TOW VEHICLE?

q

STATE

YES – ATTACH COPY OF REGISTRATION

q

ZIP

NO

NAME OF PERSON AND OR COMPANY AUTHORIZING THE TOW: ________________________________________________________

VEHICLE OWNER INFORMATION
OWNER NAME (PRINT)

CO-OWNER NAME (PRINT)

VEHICLE INFORMATION
YEAR

MAKE

MODEL

BODY STYLE

COLOR

VEHICLE IDENTIFICATION NUMBER (VIN)

VEHICLE INFORMATION CERTIFICATION
Knowingly making a false statement on this form is punishable by a penalty not exceeding: $1,000, or 10 years imprisonment, or both.
Any willful misinformation provided with fraudulent intent may be prosecuted under Maryland law.
I solemnly affirm, under penalties of perjury, and upon personal knowledge, the contents of the foregoing paper are true to the best of my knowledge and/or
belief. I have the lawful right to possess the vehicle.
PRINTED NAME OF PROVIDER

SIGNATURE OF PROVIDER

DATE

NOTIFICATION CERTIFICATION
Any willful misinformation provided with fraudulent intent may be prosecuted under Maryland law.
I hereby certify, under penalties of perjury, that all required notifications to vehicle owner and lien holder (if applicable) have been made, pursuant to Maryland
law (TR 15-509 and 25-209), and documentation showing such notification is attached.
PRINTED NAME OF PERSON MAKING THE NOTIFICATION

DATE VEHICLE ACQUIRED

SIGNATURE OF PERSON CERTIFYING THE NOTIFICATION

AUTOMOTIVE DISMANTLER AND RECYCLER OR SCRAP PROCESSOR INFORMATION
COMPANY NAME (PRINT)

LICENSEE’S NAME

LICENSE NUMBER

STREET ADDRESS

CITY

STATE

ZIP

LOCATION WHERE VEHICLE IS BEING HELD (IF DIFFERENT FROM ABOVE)

In processing this vehicle, I affirm to the best of my knowledge and belief that I have complied with all applicable Federal and State laws.
PRINTED NAME

AUTHORIZED SIGNATURE

DATE

For more information, please call: 410-768-7000 (to speak with a customer service representative).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov
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