Not your form, and worth recognising for exactly that reason. This is what an insurance company files when it has settled a total loss and cannot get the certificate of title out of the owner or the lienholder within thirty days. It is here because a seller whose car has been written off will see it referred to, may be asked to sign something that is not it, and should know what the insurer is actually allowed to do when the title has gone missing.
Written against DPSMV 1807 (R0418), issued under R.S. 32:707(I), application for salvage title by an insurer. The revision is R0418. If you are being asked to sign something during a total loss settlement, check which document it is: this affidavit is sworn by the insurer, the salvage-reconstructed application is sworn by the owner or rebuilder, and neither is a substitute for endorsing the certificate itself.
Two documents, and they are not the same thing. Take the blank DPSMV 1807 from the public.powerdms.com copy so you get the revision that is current today.
This is the actual DPSMV 1807, rendered from the PDF the Louisiana Office of Motor Vehicles publishes and completed end to end: letterhead, every field, and the blocks at the foot.
The name box at the head of the sheet, with a phone number and a mailing address under it.
Watch out: The insurance company, or an authorised agent acting for it. An owner's name here is the clearest possible sign that the wrong form is being filled in.
First box of the vehicle block.
Watch out: It has to match the vehicle the claim was paid on. This affidavit is the department's only evidence of ownership in the absence of an endorsed certificate, so the identification has to be exact.
Under the vehicle description row, with a state box beside it.
Watch out: Often blank, because the whole reason for the affidavit is that the certificate could not be obtained. Where the insurer knows the number from its own file, giving it saves the department a search.
The blank in the sworn paragraph.
Watch out: The full name of the insurer as it is registered. Where an agent is applying in its own name instead, the file also needs a notarised authorisation from the insurance company naming that agent and describing the vehicle in full.
A date in the second sworn statement.
Watch out: This is the date the thirty days ran from. It is the single most consequential figure on the sheet, because it is what makes the affidavit available at all.
Bottom right, under the notary's signature and printed name, with two witness rules facing it.
Watch out: Two witnesses and a notary on this one. The identification number goes in the box that names it, and the rules beside it carry no fillable boxes because the department expects them signed in ink.
| On the form | What to put in it |
|---|---|
| Party Making Application For Title | Name, phone, mailing address, city, state and ZIP, and a signature rule for an authorised representative. |
| Vehicle information | VIN, then year, make, model and colour, then title number if available with a state box beside it. |
| The statutory recital | In accordance with Louisiana R.S. 32:707, if an insurance company or its authorized agent is unable to obtain the certificate of title from the owner(s) or lienholder within thirty days from the settlement of the property damages claim, the insurance company or its authorized agent may submit an application for a salvage title. |
| I, ______ (Insurance Company/Authorized Agent), swear under penalties of perjury that: | The name of the insurer, in a blank. |
| (i) the written attempts | This office has been unable to obtain the certificate of title from the owner(s) or lienholder; the insurance company has made at least two written attempts to the titled owner(s) or lienholder by certified mail, return receipt requested, or by use of a delivery service with a tracking system, to obtain the endorsed certificate of title. |
| (ii) the payment | The insurance company has made payment of a proof of loss claim involving the motor vehicle on ______ - a date. |
| Signature, Date | Two positions on one row, above the witness and notary block. |
| Witness Signature/Printed Name, twice | Two rules stacked at the bottom left of the sheet. |
| Notary Public Signature/Printed Name, Notary ID # | Two positions down the right. |
| The note | All written attempts and proof of mailing must be included with the application. |
Every line here was read off DPSMV 1807 (R0418) itself — the PDF is here — and off the Louisiana Office 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.
Back to all Louisiana seller paperwork, or what selling a car in Louisiana involves.