The insurer's break-glass form, on this page so a seller reads it rather than fills it: used only when the insurance company is unable to obtain the properly endorsed title after disbursing a total loss settlement, or when it abandons the vehicle to a licensed auction. It certifies the owner elected to retain the salvage, documents two written attempts to reach them, and applies for the salvage or junk title over the missing signature - with a $9.00 fee and a thirty-day filing window.
Written against 78-032 (Rev 05/22), issued under the insurance company or licensed auction - the form's own foot says forms must be completed by the Insurance Company or Auction.
Salvage and Junk are different boxes with different futures: a salvage vehicle can be rebuilt, inspected and retitled; Mississippi will never again title a junk vehicle. If an insurer's letter offers you a choice of retained-salvage outcomes, that tick is the whole resale value of what you are keeping.
Two documents, and they are not the same thing. Take the blank 78-032 from the dor.ms.gov copy so you get the revision that is current today, then print our 78-032 guide and keep it beside you while you fill theirs in.
This is the actual 78-032, rendered from the PDF the Mississippi Department of Revenue, Motor Vehicle Services 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
The actual 78-032 at Rev 05/22, completed from the insurer's side of the counter - the only side that lawfully files it. The ticked For Insurance Company certification is the form's spine - it swears that two written attempts to the owner, the request letter and proof the lienholder was protected are attached - and the agent's signature with position title goes on in ink, inside thirty days of the settlement money moving.
Field by field
Every line, in the order you meet it
1
The insurance agent fills this in
The precondition, honestly met
The insurer confirms it disbursed a settlement and genuinely cannot obtain the endorsed title, or abandoned the unit to a licensed auction.
Watch out: For the seller reading along: this box is about your unanswered mail. The form exists downstream of silence.
2
The insurance agent fills this in
Salvage or junk
One box, matching what the owner elected to retain and what the vehicle is.
Watch out: Sellers, note the asymmetry before agreeing to anything on the phone: salvage can be rebuilt and retitled after inspection; junk is forever.
3
The insurance agent fills this in
The evidence checkboxes
The written attempts, the request letter, the lienholder proof - or the auction's parallel set with proof of delivery.
Watch out: Certified copies attach; the Title Bureau reads them against the certification, and any incomplete form will be rejected is printed where the agent signs.
4
The insurance agent fills this in
Vehicle, owner, claim, dates
VIN through settlement date, the file's whole identity in one block.
Watch out: The date of settlement starts the thirty-day submission window; the date of total loss anchors the brand. They are different dates doing different work.
5
The insurance agent fills this in
Signature and position
The authorized agent signs with their position title, for the company or the auction.
Watch out: A seller shown this form afterwards should read one thing first: whether the box says salvage or junk, because that word is now the vehicle's biography.
At a glance
What goes where
On the form
What to put in it
The hard precondition
The capitals across the top: FORM MUST BE TYPED OR COMPUTER PRINTED AND CAN ONLY BE USED WHEN THE INSURANCE COMPANY IS UNABLE TO OBTAIN THE PROPERLY ENDORSED TITLE AFTER DISBURSING A TOTAL LOSS SETTLEMENT OR WHEN INSURANCE COMPANY ABANDONS VEHICLE TO LICENSED AUCTION.
The election and the brand
The undersigned certifies the vehicle has been declared a total loss and the owner of the vehicle has elected to retain the salvage - then one of two boxes, Salvage or Junk.
The insurance company's evidence
Three attachments certified as sent to the owner: two (2) written attempts to the owner to obtain the current certificate of title, a letter of request for a salvage / junk title, and proof the lienholder's interest was protected.
The auction's evidence
The parallel certification for an abandoned-to-auction vehicle: two written attempts to the owner and lienholder with proof of delivery, and the letter of request.
The vehicle and the claim
VIN, make, model and year, the owner's name, the claim number, the insurance company's name and address, the authorized agent's name, the date of total loss and the date of settlement, and the agent's signature with position title.
The deadline at the foot
This form must be submitted to the Department of Revenue Title Bureau within 30 days after the total loss settlement has been disbursed. Any incomplete form will be rejected.
What gets this one rejected
•A seller submitting it. The foot assigns authorship - forms must be completed by the Insurance Company or Auction - and an owner's version of this situation is the ordinary signed title, not this form.
•Handwriting. The precondition line requires it typed or computer printed; the fillable PDF exists because the Title Bureau will not read pen on this one.
•Certifying attempts that were not made. The two written attempts are the form's whole legal engine - it moves a title without the owner's signature on the strength of them.
•A protected lienholder taken on faith. The insurance route attaches proof the lienholder's interest was protected; a lender left dangling is exactly what the attachment exists to prevent.
•Missing the window. Thirty days from settlement disbursement, and incomplete forms are rejected - late plus incomplete is how these files die.
Rules that decide whether it is accepted
•What this means for a seller. If you take a total loss settlement and keep the signed title in a drawer, this form is what eventually happens - the insurer titles the wreck over your silence, after two certified attempts. The letters it certifies sending are real letters; answering the first one keeps your name out of a file built on your non-cooperation.
•Owner-retained is a different road. Where you keep the salvage and the insurer never takes the title, the salvage pages apply instead: the owner surrenders the certificate to a designated agent within thirty days of the vehicle becoming salvage, and a rebuild goes through the DPS inspection to a Rebuilt title before it can be sold on.
