How a wrecked Indiana car gets the brand that says so. Four sections - owner, insurance company, vehicle, affirmation - and an insurance block that is marked if applicable, which is the tell that this is not only an insurer's form. An owner who has decided a car is finished can request the salvage title themselves, and the BMV's own page says a salvage title is required for vehicles manufactured within the last seven model years that have been wrecked or damaged.
Written against State Form 49891 (R4 / 12-24), issued under IC 9-22-3.
Get the branding decision right before you sign, because it is not reversible by this route. A vehicle that could be repaired and retitled is worth a conversation with the insurer first - once the salvage title issues, the only way back is a restoration application and an inspection.
Two documents, and they are not the same thing. Take the blank State Form 49891 from the forms.in.gov copy so you get the revision that is current today.
This is the actual State Form 49891, rendered from the PDF the Indiana Bureau of Motor Vehicles publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
Filled in for a flood loss the insurer settled. The insurance block is amber here because there was a settlement - on an owner-initiated salvage title with no insurer involved, that whole section stays empty and the form is still complete.
Field by field
Every line, in the order you meet it
1
You fill this in
Section 1, the owner
Owner names in the order last, first, middle initial or company name, and a legal address.
Watch out: Every name on the certificate goes here. This is a request to brand the vehicle and it is made by whoever owns it, which on a jointly-titled car is both of you.
2
You fill this in
Section 2, only if there is an insurer
Company Name, Agent Name and the insurer's address.
Watch out: If applicable is a real condition, not politeness. An owner who is branding a car they gave up on themselves leaves the whole section blank.
3
You fill this in
Section 3, the vehicle
Identification number, year, make and model.
Watch out: Take the number off the certificate. On a badly damaged car the plate on the dash may no longer be readable, and if it is not, the vehicle needs a special identification number before anything else happens.
4
You fill this in
Date of Settlement
The date the insurer settled the claim.
Watch out: Leave it empty if there was no claim. A date invented to fill a box is a date somebody may one day ask about.
5
You fill this in
Reason
A short description of what happened to the vehicle.
Watch out: Be specific - flood, collision, fire, theft recovery. The word here is what a future buyer's history report will effectively be built on.
6
You fill this in
Section 4, sign it
Signature of Owner, printed name and date, under a certification that the vehicle meets the salvage title requirements of Indiana Code.
Watch out: You are certifying that the car qualifies, which means you should know why it does. Wrecked or damaged within the last seven model years is the BMV's own test.
7
You fill this in
Send it with the certificate
The affidavit, the existing certificate of title and the fee, to the address in the salvage packet.
Watch out: The salvage packet is published separately and lists every enclosure. Posting the affidavit on its own is the commonest reason one of these comes back.
At a glance
What goes where
On the form
What to put in it
SECTION 1 - OWNER INFORMATION
Owner names in the order last, first, middle initial or company name, then a legal address with city, state and ZIP.
SECTION 2 - INSURANCE COMPANY INFORMATION (if applicable)
Company Name and Agent Name, with the insurer's address beneath. The parenthesis is the important part of the heading.
SECTION 3 - VEHICLE INFORMATION
The Vehicle Identification Number in its banded box, then Vehicle Year, Vehicle Make and Vehicle Model on the row below.
Date of Settlement and Reason
Two boxes at the foot of section 3. Settlement is the insurer's word; Reason is where the damage is described.
SECTION 4 - AFFIRMATION STATEMENT
A request that the BMV issue a salvage title, and a certification that the vehicle meets the salvage title requirements of Indiana Code.
Signature of Owner
One row - signature, printed name, date - under the perjury affirmation and an indemnity of the BMV.
What gets this one rejected
•Treating it as a way to cheapen an old car. It changes what the vehicle legally is, permanently, and there is no ticking a different box next time.
•Leaving the Reason box empty. It is the only place on the page where the actual damage is described, and a salvage title issued on a blank reason is a title issued on nothing.
•An insurance block filled in for a settlement that never happened. The heading says if applicable, and an owner scrapping their own car has no insurer to name.
•A date of settlement that predates the damage. The two ought to make sense side by side, and a branch reading them together will notice if they do not.
•Using it to restore a brand. Getting a rebuilt brand back onto a car that was branded salvage is a different affidavit and a different packet.
•Selling to a private buyer without saying so first. The brand follows the vehicle and the buyer will discover it at the counter if not before.
Rules that decide whether it is accepted
•Seven model years is the trigger, not the limit. The BMV's own wording is that a salvage title is required for vehicles manufactured within the last seven model years that have been wrecked or damaged - and that when requested, a salvage title may be issued for a vehicle over seven model years old.
•It is a Central Office process. The salvage packet is one of the applications the BMV processes centrally rather than at a branch, and the packet lists what has to go with the affidavit.
•The owner signs, not the insurer. Section 4's signature row is Signature of Owner. Section 2 records who settled; it does not change who is swearing.
Every line here was read off State Form 49891 (R4 / 12-24) itself — the PDF is here — and off the Indiana Bureau of Motor Vehicles pages.
This is plain-language help with a form, not legal advice, and where our wording and the agency's differ,
theirs governs.
